Payment and Delivery-System Reform — The Next Phase

After nearly a decade of experimentation with value-based payment (VBP), U.S. health care payers, providers, and purchasers are confronting uneven adoption of new care guidelines, modest early results, and stillunacceptable gaps in spending and quality. In determining what comes next, we believe it’s important to extrapolate from the lessons of these experiences to guiding principles for designing new approaches. It’s also essential to recognize that to truly redesign a system, one has to take a holistic approach and move multiple levers in concert, rather than fiddling with individual factors serially and hoping for a coordinated effect. Though we focus on tactics for private payers to consider, many of these principles and a holistic strategy could also be adapted to Medicare or Medicaid contexts.