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Congress should replace today’s program-by-program approach to value-based purchasing with a unified platform of expected medical and patient-reported outcomes, defined uniformly, risk adjusted or stratified uniformly, and used across all payers.
For a quarter of a century, the US has graded health care primarily on process and documentation — whether a box was checked, a form was filed, if a protocol was noted in the chart. Value-based purchasing, paying for what happens to patients, has been the holy grail of quality measurement from the start. But when today’s programs were built, the grail was out of reach. Clinical information lived on paper and in billing claims; only checked boxes and filed forms could reliably be counted at scale. When outcomes were attempted at all, they were based on crude proxies like total cost of care. So, what could be measured was measured, and what was measured stayed. The result is a problem most don’t want to admit: a value-based payment system that is not really about the value of care.
We should be beyond paper and placeholders. The constraints have expired. Electronic records are a reality in nearly every hospital and physician practice, and data standards increasingly let them speak to one another. Computation that once made outcome measurement and trustworthy risk adjustment prohibitive is now inexpensive. For the first time, the health care consumers and purchasers could achieve what I term “buy right”: the right care, at the right price, with the right results.
I argue that Congress should replace today’s frozen, program-by-program approach to value-based purchasing with a unified platform of expected medical and patient-reported outcomes, defined uniformly, risk adjusted or stratified uniformly, and used across every payer. Three design decisions will determine whether we finally buy right: a common yardstick, dynamic measures with a lifecycle, and actionable accountability for all who compile the scores.