Improving Evaluations of Value-Based Purchasing Programs

Although there is an eagerness to understand more about value-based purchasing (VBP) in health care, research methods examining the impact and implementation of the programs must be improved, according to this essay in Health Service Research in 2020.

Value-based purchasing, commonly called pay-for-performance, is a fundamental reform of how providers are reimbursed for care, shifting away from the fee-for-service model commonly used. If done right, VBP should encourage providers to be efficient and focused on quality of care and patient outcomes. However, this essay’s authors note significant shortcomings to the limited research available on VBP.

Key Points:

  • Data collection related to the implementation of VBP programs should start early and be continuous. Ideally, implementation researchers would become involved during the planning of the program. However, government approvals of the implementation research plan can take 7-9 months. VBP program planners are reluctant to delay the program’s development pending approval of the implementation research plan. The research approval process must be streamlined.
  • VBP programs also are very limited in design and participants, making it difficult to generalize results.
  • Studies on the impact of VBP are limited by inadequate outcome measures. It is particularly difficult to develop the complex measures necessary to assess outcomes associated with “bundled services” encouraged by payment reform.
  • Analysis of VBP outcomes also requires the availability of patient-level data across care settings which raise significant questions about technology, data compatibility and patient confidentiality.

The authors suggest convening a roundtable of quantitative and qualitative experts to examine how researchers could conduct synthesis or meta-analysis research of VBP evaluations. While there is an eagerness to reform the payment system, the authors warn this should not overshadow the need for rigorous implementation and impact research.