OUR PRINCIPLES
The U.S. health care system needs new systems of payment that promote affordability, advance clinical quality and foster prevention, coordination, safety and better patient outcomes. These payment changes must be done hand-in-hand with more effective engagement of patients in making decisions based on having better information and incentives.
Policymakers in both public and private settings are focusing on new forms of payment that could potentially result in better value, including new payments for primary care, bundled payment, pre-payment and paying for care of entire populations, as well as improving current types of payments. The details of payment reforms will be critical to their impact and must be guided by a clear set of goals and principles supported by public and private sector stakeholders.
Policymakers in both public and private settings are focusing on new forms of payment that could potentially result in better value, including new payments for primary care, bundled payment, pre-payment and paying for care of entire populations, as well as improving current types of payments. The details of payment reforms will be critical to their impact and must be guided by a clear set of goals and principles supported by public and private sector stakeholders.
The following principles were developed by the Center for Payment Reform (CPR), an initiative of the Consumer-Purchaser Disclosure Project, representing consumers, purchasers, labor, physicians and other health care providers, payers and policymakers who have come together based on their shared vision that improving quality and affordability in health care requires a transformation in our payment systems. Payments for the prevention, diagnosis and treatment of disease should be assessed based on the extent to which they meet the following patient-centered and societal goals:
- Promote and reward high quality, patient-centered care that is cost-effective and reduces disparities
- Ensure patients receive the "right care, at the right time, from the right provider," incorporating the values and preferences of patients
- Foster improvement and innovation
- Effectively slow the growth of the costs of health care
Reforms to the U.S. health care payment systems, including improvements to the current system and development of new forms of payments, should reflect the following six core payment principles:
- Payment reforms should promote health by rewarding the delivery of quality, cost-effective and affordable care that is patient-centered and reduces disparities.
- Health care payments should encourage and reward patient-centered care that coordinates services across the spectrum of health care providers and care setting while tailoring health care services to the individual patients' needs, values and preferences.
- Payment policies should encourage alignment between public and private health care sectors to promote improvement, innovation and meeting national health priorities, and to minimize the impact of payment decisions in one sector on the other.
- Decisions about payment should be made through independent processes that are guided by what serves the patient and helps society as a whole, and payment decisions must balance the perspectives of consumers, purchasers, payers and physicians and other health care providers.
- Payment policies should foster ways to reduce expenditures on administrative processes (e.g., claims payment and adjudication).
- Reforms to payment should balance the need for urgency against the need to have realistic goals and timelines that take into account the need to change complex systems and geographic and other variations.