The Future of Payment Policy

by Holly Russo, RN, MSN, MS, ECS, PatientCraft CEO

While healthcare policy has been a hot topic of late, one component is consistently overlooked: payment policy.

Because this is a vital component to reform, I wanted to get some thoughts on the subject from an industry expert. I had the privilege to listen to Jack Wennberg, one of the fathers of assessing variation and its impact on costs and quality.

“If healthcare reform concentrates on four goals,” Wennberg said, “then the value of care will increase and growth in healthcare costs will decrease.” The goals are as follows: 1) promote organized healthcare delivery; 2) establish informed patient choice around tests, procedures, drugs, elective surgeries and end-of-life care; 3) improve the science of healthcare delivery; and 4) constrain undisciplined growth in spending and capacity.

To accomplish these goals, we must understand the questions to ask, the data needed to make assessments, the significance of conclusions reached and the strategies needed to make successful change.

There are some potential hiccups. For example, drug therapy may have potential conflicts among patient preference, administration goals, and clinicians around prescriptions.

For years, hospitals have encouraged generic medications inside hospital walls. However, in outpatient-filled prescriptions, brands produce more savings. Many patients prefer brand-name medicine, but many experts question patient understanding of generic equivalents.

This issue is an example of a topic where many people may avoid the problem rather than candidly tackle it to understand how to make informed and ethical decisions.

Today we face some of the most significant changes in payment policy, and an increased focus on quality of care to outcome and reimbursement. Those who try to hide from the problems will be out of business; however, those that look critically at how, where and when care is accessed and delivered will be ready to embrace the future.

It is important that we approach the issues directly and transparently share our results so we can better deliver care.