Payment Reforms Need a Balanced Approach to Evidence

News Update

Payment Reforms Need a Balanced Approach to Evidence

Date

February 28, 2017

How do we know that benefit and payment reforms are improving quality and lowering costs?

In a Viewpoint published today in the Journal of the American Medical Association William Shrank of University of Pittsburgh Medical Center, Duke-Margolis Director Mark McClellan and Research Director Robert Saunders observe that while benefit and payment reforms are being implemented in large numbers, there is mixed and very limited evidence on outcomes and costs.

In this opinion piece, the authors argue that evaluations designed to align with stakeholder needs – whether academic rigor, speed, timely feedback, flexibility, or scalability – could help broaden implementation of payment reforms while also supporting better policy making.  To date, the different needs of stakeholders have driven variation in what types of evidence and how much evidence is needed to conclude that a given reform is successful, given their goals. An approach balancing momentum and timeliness with convincing evidence and the flexibility to modify reforms over time can give healthcare providers more support in improving their approach and provide more evidence.

They urge those working in benefit design and payment reform consider methods used by private insurers, employers, and health systems, including adaptive research methods that can raise confidence in reform outcomes and identify areas where more rigorous study may be needed.  The Centers for Medicare and Medicaid Services could support such efforts with standardized feedback delivered more frequently, enabling aggregation of data and exchange of findings from multiple sources of evidence.