Here are some fresh perspectives on living in the  new world of paying for value from  a HealthAffairs blog entry.

The authors note that part of the difficulty in moving value-based care is provider benchmarks that reward improvement rather than current level of performance, “further complicated by the constant downward pressure on payment benchmarks, which not only reduces or erases any prior gains, but also threatens to put the already high-value providers out of business. Additional issues observed  include inaccuracies with patient attribution, inconsistently set cost and quality targets, and the near-complete lack of patient involvement.”

The authors write that “Global-based payment systems  (e.g., bundled payments and full capitation) are more conducive to higher value health care.”

The authors elaborate on what they see as the key elements of    successful global-based payment models and provide advice on how to create them.

At the end they suggest that:

“Given the high concentration of healthcare spending on a small group of highly complex patients (20 percent of patients account for 80 percent of the cost), we feel that these novel payment approaches should be first designed and deployed to address the care and needs of those high-need, high-cost populations, rather than serving as a payment approach ‘for all.”’