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RWJF Program Evaluations

An RWJF Collection

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Evaluation of Value-Based Payment Reform

Conducted from 2010 through 2015.
    • December 1, 2016

About the Program Being Evaluated

Spanning a period of five years (2010 through 2015), the Robert Wood Johnson Foundation supported 11 pilots of value-based payment approaches. These payment reform projects sought to change behavior of individual providers and provider organizations by aligning payment with value—using financial incentives that aim to improve clinical quality and outcomes for patients, while also either containing or reducing health care costs.

About the Evaluation

The value-based payment approaches were evaluated by University of Washington researchers. Executive summaries of the evaluations of each of these projects examine the experiences of eleven independent multi-stakeholder initiatives in eight states (California, Maine, Massachusetts, New Hampshire, Oregon, Pennsylvania, Vermont, and Washington).

Knowledge and Impact

The summaries of each of those projects describes the respective contexts, specific objectives, logic models, strategies, and barriers to and facilitators of implementing value-based reform, as well as results and lessons learned. Also resulting from this evaluation work was the creation of a conceptual framework for evaluating the implementation of multi-stakeholder value based payment initiatives, published in Medical Care Research and Review. The authors also published a summary that brings together lessons from the first round of projects in Milbank Quarterly, and a blog post in Health Affairs that brings together lessons from across these projects, including the following:

Key Findings

  • Organized health care purchasers—especially large self-insured employers and public purchasers—must demand that health plans and providers move away from volume-driven to value-driven payment.

  • Collective agreement among multiple payers and provider organizations on payment method is extremely difficult and generally elusive, largely because of competing economic interests. However, this consensus is essential to secure broad multi-payer participation and to send uniform signals to providers within a common payment structure.

  • Strong anti-trust vigilance and appropriate regulation are critical to ensure health plan and payer competition in the public interest.

  • Public transparency of health plans’ prices and provider organizations’ quality metrics is a key ingredient in the menu of public policy options.

If there are questions about the evaluation or interest in other products of this effort, please contact Doug Conrad at dconrad@uw.edu.