Recommendations of the 2008 NRHI Payment Reform Summit

Harold Miller coined the phrase, ‘from Volume to Value,’ and helped people understand that a major cause of the quality and cost problems in healthcare today is that payment systems encourage volume-driven healthcare rather than value-driven healthcare. Fortunately, there are better ways to pay for healthcare, including episode-of-care payment systems and condition-specific capitation systems, which give healthcare providers more responsibility for increasing quality and controlling costs of services without penalizing them financially for treating sicker patients.

There are a number of important issues that need to be addressed and a variety of challenges that need to be overcome in order to move these improvements from concept to reality:

  • Which healthcare providers are able and willing to accept new payment structures and deliver value-based care?
  • How should the use of high-value providers and services be encouraged? What protections are needed to ensure appropriate quality for patients?
  • How can payers and providers be encouraged to participate in new payment and delivery systems? How similar do different payers’ systems need to be?
  • What kinds of pilot projects are needed to test new payment systems?
  • What community-wide structures are needed to support payment reform?
  • The recommendations of more than 100 healthcare leaders from across the country for addressing these issues are described in detail in this report.


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