Current State of Value-Based Purchasing Programs
Current State of Value-Based Purchasing Programs
复制标题
DOI：
10.1161/circulationaha.115.010268
复制
发表时间：
2016-05-31
期刊：
影响因子：
37.8
通讯作者：
Borden, William B.
中科院分区：
文献类型：
--
作者：
Chee, Tingyin T.;Ryan, Andrew M.;Borden, William B.
美国的医疗保健系统正在迅速走向回报价值。最近的立法，如《平价医疗法案》和《医疗保险准入和芯片再授权法案》，巩固了基于价值的支付在医疗保险中的作用。许多私人保险公司正在效仿医疗保险公司。大部分政策关注的是可问责的医疗组织和捆绑支付等项目;然而，基于价值的采购（VBP）或按绩效付费（定义为提供者按服务付费，并根据价值指标向上或向下调整付款）仍然是Medicare Access和CHIP Reauthorization Act中价值支付的核心要素，并且在可预见的未来可能仍然如此。这篇评论文章总结了越南船民计划的现状，并提供了优势，劣势和未来的机会分析。已经实施和评估了多个住院和门诊VBP计划;这些计划的影响微不足道。提高VBP计划绩效的机会包括提高质量测量科学，加强激励措施的规模和设计，减少健康差距，建立广泛的结果测量，选择适当的比较目标，并确定VBP相对于替代支付模式的最佳作用。VBP计划将在未来几年的医疗保健服务中发挥重要作用，它们为提供者提供了一个机会，以建立以价值为导向的护理所需的基础设施。
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.