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Review
. 2016 May 31;133(22):2197-205.
doi: 10.1161/CIRCULATIONAHA.115.010268.

Current State of Value-Based Purchasing Programs

Tingyin T Chee  1 , Andrew M Ryan  1 , Jason H Wasfy  1 , William B Borden  2
Affiliations
Review

Current State of Value-Based Purchasing Programs

Tingyin T Chee et al. Circulation. .

Abstract

The US healthcare system is rapidly moving toward rewarding value. Recent legislation, such as the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act, solidified the role of value-based payment in Medicare. Many private insurers are following Medicare's lead. Much of the policy attention has been on programs such as accountable care organizations and bundled payments; yet, value-based purchasing (VBP) or pay-for-performance, defined as providers being paid fee-for-service with payment adjustments up or down based on value metrics, remains a core element of value payment in Medicare Access and CHIP Reauthorization Act and will likely remain so for the foreseeable future. This review article summarizes the current state of VBP programs and provides analysis of the strengths, weaknesses, and opportunities for the future. Multiple inpatient and outpatient VBP programs have been implemented and evaluated; the impact of those programs has been marginal. Opportunities to enhance the performance of VBP programs include improving the quality measurement science, strengthening both the size and design of incentives, reducing health disparities, establishing broad outcome measurement, choosing appropriate comparison targets, and determining the optimal role of VBP relative to alternative payment models. VBP programs will play a significant role in healthcare delivery for years to come, and they serve as an opportunity for providers to build the infrastructure needed for value-oriented care.

Keywords: costs and cost analysis; outcome assessment (health care); reimbursement mechanisms; value-based purchasing.

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Conflict of interest statement

Conflict of Interest Disclosures: William B. Borden – salary as the Director of Healthcare Delivery Transformation at the George Washington University Medical Faculty Associates. Jason H. Wasfy – salary as assistant medical director of the Massachusetts General Physicians Organization.

Figures

Figure 1
Figure 1
A variety of payment models aim to improve healthcare value, with varying degrees of accountability and financial risk. This review paper discusses pay-for-performance, often known as value-based purchasing (VBP). VBP is the first step from fee-for-service on the spectrum toward more comprehensive and higher financial risk programs.
Figure 2
Figure 2
The design and evaluation of value based purchasing programs depend on the external environment, provider characteristics and program features. This figure provides examples in each of those components.
See this image and copyright information in PMC

References

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MeSH terms