Value-Based Provider Payment Initiatives Combining Global Payments With Explicit Quality Incentives: A Systematic Review

Med Care Res Rev. 2020 Dec;77(6):511-537. doi: 10.1177/1077558719856775. Epub 2019 Jun 19.

Abstract

An essential element in the pursuit of value-based health care is provider payment reform. This article aims to identify and analyze payment initiatives comprising a specific manifestation of value-based payment reform that can be expected to contribute to value in a broad sense: (a) global base payments combined with (b) explicit quality incentives. We conducted a systematic review of the literature, consulting four scientific bibliographic databases, reference lists, the Internet, and experts. We included and compared 18 initiatives described in 111 articles/documents on key design features and impact on value. The initiatives are heterogeneous regarding the operationalization of the two payment components and associated design features. Main commonalities between initiatives are a strong emphasis on primary care, the use of "virtual" spending targets, and the application of risk adjustment and other risk-mitigating measures. Evaluated initiatives generally show promising results in terms of lower spending growth with equal or improved quality.

Keywords: accountable care; global payments; pay-for-performance; provider payments; value-based health care.

Publication types

  • Systematic Review

MeSH terms

  • Aged
  • Delivery of Health Care
  • Humans
  • Medicare*
  • Motivation*
  • United States