This issue brief from the Center for Healthcare Quality and Payment Reform describes ten barriers to health care payment reform and then outlines solutions to overcome each of  them. The ten barriers are:

  1. Continued use of fee-for-service payment in payment reforms

2. Expecting providers to be accountable for costs they cannot control

3. Physician compensation based on volume, not value

4. Lack of data for setting payment amounts

5. Lack of patient engagement

6. Inadequate measures of the quality of care

7. Lack of alignment among payers

8. Negative impacts on hospitals

9. Policies favoring large organizations

10. Lack of neutral convening and coordination mechanisms

According to the issue brief, fee-for-service payment must be replaced entirely with a new payment system that gives providers (a) greater flexibility to deliver the best combination of services for the patient, and (b) the accountability to ensure the combined cost of those services is less than the payment amount (along with the ability to retain any additional savings generated indefinitely). Examples of such better payment systems include “episode-of-care” payments and “global” payments or condition-specific comprehensive care payments.

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