Healthcare thought leaders, including providers, payers and consultants, gathered in Appleton on April 29 and 30 to explore how they might accelerate progress in payment reform.
On April 29 and 30, healthcare thought leaders from Maine to California gathered in Appleton to explore how they might accelerate progress in payment reform. Participants included providers, payers and consultants.
As we discussed the current state of payment reform, it became clear that the landscape features a seemingly endless array of opportunities to change payment systems. However, participants expressed their shared concern that the current pace of change is not fast enough. One participant reframed the “foot in two canoes” analogy as applied to the split between fee for service and value-based reimbursement. She observed that a more apt metaphor might be that of standing on the side of a turbulent river. The near bank represents the current fee for service environment; the far bank represents value-based payment of some kind, although the precise contours of the far bank can’t be discerned for all of the fog and spray coming off the river.
The rushing river represents the difficulty of change, and there is a waterfall some undetermined distance downstream. Once you step off the near bank, you have to get across the river to avoid the waterfall, but the best way to make the crossing and the specific destination that should be targeted, are difficult to determine.
What might that far bank look like? Participants were clear that the “ideal state” would feature incentives that rewarded the best care at the lowest cost. As payment systems shift from volume to value, patients must be more fully engaged in caring for their own health, not just in making smart decisions about their healthcare. Supporting patients in living well requires healthcare organizations to engage beyond their boundaries and consider the conditions in communities that do, or don’t, make it easy for people to make healthy choices.
The gaps between these two worlds remain significant. Participants described the difficulty of this work as a two-sided coin: participants expressed frustration with their limited ability to make meaningful change within the constraints of what some characterized as a fundamentally broken system, but they also acknowledged the flip side: fear of the consequences of transformative change. No sector-provider, payer, purchaser, consumer- was thought to be truly ready to do what needs to be done to bridge these gaps.
So, what to do? The leaders who gathered at the end of April in Appleton expressed a strong interest in continuing to learn from each other, possibly by creating a “learning-doing” community where they could test potential answers to some of the hardest questions they are facing. The Center will continue to explore this possibility with these leaders. Interested in learning more? Contact Karen Timberlake at firstname.lastname@example.org.