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.
