Value-based payment reform - VBP: meeting
8 important questions on Value-based payment reform - VBP: meeting
What is fee-for-service
Why is fee-for-service poorly aligned with value? (4x)
- Rewards volume
- Maintains fragmentation
- Discourages prevention
- Has no link with quality
What is pay-for-performance?
- Higher grades + faster learning
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What are predefined indicators of pay-for-performance?
- Performance often operationalized as quality of care, usually measured using process indicators (≠ outcome!)
- P4P typically applied as relatively small add-on to existing payment structures (leaving incentives in those underlying payments intact)
What are the advantages of pay-for-performance? (3x)
- Theoretically and intuitively appealing
- May contribute to better care (if done well)
- May enable providers to invest in quality
What are the limitations / risks of pay-for-performance? (3x)
- 'Performance’ difficult to measure (especially outcomes)
- Flawed incentives in underlying payment system left intact
- Might lead to undesired strategic behaviour
What are the advantages of bundled payments? (4x)
- Minimize costs for care covered by the payment
- Coordinate care well, realize seamless integrated care
- Improve quality by reducing harmful overtreatment
- Prevent complications (if part of bundle)
What are the limitations / risks of bundled payment? (4x)
- Unwarranted increase in the number of bundles
- Underutilization of necessary services
- Risk selection (‘cherry picking’)
- Compartmentalization of patients into separate conditions
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