Commentary Addresses Market Challenges to Payment Reform Evaluation

As Medicare ACOs and value-based payment arrangements proliferate in the U.S. healthcare market, so does concern about how spillover effects in health care markets may increase the difficulty of evidence-based decision making on payment reforms.

In a commentary published today on the blog of the journal Health Affairs, Duke-Margolis’ Hongmai Pham, Robert Saunders, William Bleser and Mark McClellan, along with William Shrank of the UPMC Health Plan and Michael Chernew of Harvard Medical School, discuss the market dynamics that result in spillover effects, including:

From one payer’s beneficiary population to another payer’s population within the same physician organization;
From a provider participating in a payment reform to non-participating providers in the same market;
From signals payers and policy disseminate nationally to diffuse markets.

These effects present a significant policy concern in terms of the ability to reliably measure whether a reform produces measurable and meaningful impact. At the same time, market momentum toward value-based payment models makes it difficult to slow or limit participation.

The authors make four key recommendations for decision makers – read more on the Health Affairs Blog.