New payment models and benefit designs will change how the American health care system pays for and delivers care. With support from the Laura and John Arnold Foundation, the Duke-Margolis Payment Reform Evidence Hub aims to encourage more and better evaluations of these new models. The Hub specifically focuses on innovative payment reforms in areas where evaluations are particularly needed. These gap areas include payment reforms being implemented by private payers, commercial stakeholders, and states that often have limited resources for conducting independent evaluations on their own. Better evidence and a more diverse evidence base will allow for better understand about what works and what does not and help speed the transition to paying for value in health care.
To gather input, the Hub has held a series of public meetings and sessions with its working group. It has also been working collaboratively with the Health Care Payment Learning and Action Network (LAN). So far, the Hub has built a clearinghouse containing an inventory of payment reform evaluations, identifying where work is particularly needed. We will continue updating the inventory to reflect progress in the field.
The Hub is also working to increase the capacity for implementing evaluations. There is widespread interest from all sectors in addressing gaps, but often not enough financial resources or manpower to address the variety of barriers that can keep an organization from carrying out an evaluation.
The Hub is also pursuing evaluations of several promising payment and delivery reforms across the state and commercial sectors.
The Hub built an inventory of payment reform evaluations to assess the state of available evidence. The inventory includes all publicly available payment reform evaluations from commercial plans, Medicare, Medicaid, and other state programs. The results of the analysis appeared in a Health Affairs blog post: Identifying Gaps in Payment Reform Evidence (April 2017).
Given the findings from the payment reform evaluation inventory, the project team highlighted the need to develop better evidence in payment and delivery reforms and identified steps that could address key barriers. The Hub collaborated with Catalyst for Payment Reform to develop an approach summarized in a Health Affairs blog post on how to overcome barriers that limit an employer’s ability to evaluate programs and produce evidence.
The Hub examined the standards of evidence needed for decisions by different stakeholder groups, with the findings summarized in a February 2017 JAMA Perspective. This paper describes how evaluators can produce evidence that impacts payment reform decisions by different stakeholders and outlines different methods that could produce evidence needed by different stakeholders.
The Hub working group wrote a paper on the spillover effect (when one payment reform affects another one). Published on the Health Affairs blog, this paper outlined the difficulty of evaluating payment reforms in markets where multiple reforms interact, an increasingly common problem as payers experiment with multiple models.