ISSUE:

Recent decades have seen a dramatic rise in the share of provider payments that are linked to value. Increased use of alternative payment models could improve efficiency if these models incentivize providers to better balance clinical outcomes with treatment cost. On the other hand, quality measurement is imperfect and may not fully reflect heterogeneous patient preferences. There is an urgent need to understand: (i) how alternative payment models affect prescribing practices, and (ii) what changes to alternative payment models could be implemented to ensure patients receive high-value treatments.

OVERVIEW:

The panel will debate the pros and cons of provider alternative payment models (APMs) with a focus on whether or not APMs incentivize the use of high-value medications. Specifically, the panel will answer questions such as: Is value-based provider reimbursement influencing prescribing decisions? Can provider value-based reimbursement be improved to ensure patients get high value treatments? How can researchers adapt economic models to take the provider perspective? Dr. Shafrin will moderate the panel. He will provide an overview of APM trends and highlight recent research linking prescribing decisions to these value-based reimbursement models. Dr. Barr will provide an overview of how NCQA quality measures are being used; will describe the pros and cons of broad, cross-disease versus narrow, disease-specific quality measures; and will discuss pathways through which choice of pharmaceuticals could impact NCQA quality measures. Dr. Oyekan will describe how quality measurement and value-based reimbursement is operationalized within large IDNs and how it affects prescribing decisions. Dr. Jena will take the individual physician perspective, citing the limitations of value-based provider reimbursement, such as its limited ability to account for heterogeneous patient preferences. Dr. Jena will also describe how economic models can be adapted for a health care delivery system audience.