Making the Business Case for Payment and Delivery Reform

To support improvements in health care delivery and payment systems, individuals and organizations that purchase health care services need a clear business case showing that the proposed changes will achieve sufficient benefits to justify them. Providers also need the business case to show they will be able to successfully deliver high-quality care in a financially sustainable way under the new system. This brief, by the Network for Regional Healthcare Improvement, details the 10-step process for health care purchasers and providers to develop a sound business case to support successful reforms to both health care payment and delivery systems.

In addition to the business case, the brief outlines the four major types of data needed to successfully carry out the business case:

• Health care billing/claims data;
• Clinical data from electronic health records or patient registries;
• Data on the costs of health care services; and
• Data on patient-reported outcomes.

The authors point out that tens of billions of dollars of health care spending could be saved each year by avoiding unnecessary health care services, such as procedures, tests, hospital visits and infections. Curtailing unneeded health care spending starts with developing a business case that demonstrates how costs will be cut and care will be improved.