ABSTRACT
Donald Berwick argued that payment for healthcare services without any direct linkage to quality and outcomes created market dynamics that encouraged hospitals to fill beds and expand services to protect profits and increase revenue. Payment reform has become a national reality, and the business case for the use of population health methods to drive healthcare performance has never been stronger. However, most health systems support a mix of insurers. Risk-adjusted payment helps organizations care for complex, high-cost patients. This structure encourages insurers to provide health insurance for patients with chronic health conditions, knowing that the payment will be commensurate with probable costs. The 2019 Merit-based Incentive Payment System Quality Performance Category Fact Sheet, lists seven types of quality measures for the Quality Payment Program: process, structure, intermediate outcome, outcome, patient-reported outcome, efficiency, and patient engagement and patient experience.
