In a time of significant health care transformation, many health insurers and health care providers are moving toward payment models based on the quality of care rather than the quantity in an effort to attain the Triple Aim of better care, smarter spending, and healthier people. The U.S. Department of Health and Human Services is working toward having 90 percent of Medicare payments tied to quality by 2018, and, at the state level, many are exploring a variety of new payment approaches through State Innovation Models funded by the Center for Medicare and Medicaid Innovation (CMMI).

While these payment reform efforts have a clear tie to the smarter spending aspect of the Triple Aim, what about their impact on people’s health? Right now, most of these value-based payment models, as they’re known, focus on clinical services and specifically focus on the needs and outcomes of a particular health care provider’s patients, a health plan’s enrollees, or the purchaser’s employee subscribers. Other payment models focus on a targeted sub-population of individuals with a defined clinical condition, such as patients with diabetes or depression. As such, payment and financing models are not yet adequately supporting community-wide, that is, geographically-based, population health. The incentives in these models do not yet reward health care providers for creating healthy communities, nor do they incentivize other sectors—transportation, housing, education—for population health improvements.

In light of this disconnect between payment reform and community-wide population health, AcademyHealth, with support from the Robert Wood Johnson Foundation, is leading a new effort called Payment Reform for Population Health to identify where momentum and opportunities exist to close the gap. As a neutral broker of information, AcademyHealth supports the generation of new knowledge and the transfer of knowledge into action. Supported by a broad and diverse network of researchers, policymakers, and practitioners, AcademyHealth is uniquely positioned to collaborate and facilitate connections, create shareable resources, and co-create strategies for using payment reform to support population health improvement.

This cross-team, multidisciplinary effort brings together AcademyHealth’s experts in payment reform, population and public health, health care data management, and research and analytic methods to identify where payment reform and population health intersect (to learn more about the project team, click here).

Past RWJF-supported initiatives as well as state and federal-led demonstrations have shown that payment reform efforts supporting population health improvement face persistent challenges. Yet, the team has observed encouraging innovations in the Population Health Community of Practice during the past year and by those expected to come from the recently-launched Office of the National Coordinator funded Community Health Peer Learning Program. Beyond AcademyHealth, the team is also looking to the innovative work of others, such as the Health Care Payment Learning and Action Network (LAN). These programs and networks illustrate the on-going efforts of health systems and other stakeholders to innovate and implement successful population-focused interventions.

One of the hallmarks of this Payment Reform for Population Health initiative is its emergent approach. Because working emergently with complex issues requires ongoing attention to multiple levels of change, AcademyHealth has set up processes that support adaptation to the changing context. We have also committed to supporting discovery and knowledge sharing through strategic collaboration with those already improving population heath as well as with those developing and implementing alternative payment models. Specifically, an in collaboration with our Guiding Committee, practitioners, and other key stakeholders, we will work to:

  • leverage and learn from efforts underway and work to support and enhance their activities;
  • assist in the spread of ideas, knowledge and evidence; and
  • support those initiatives to overcome persistent, yet surmountable barriers to achieve success.

After conducting structured interviews with 18 experts and convening our first in-person Guiding Committee meeting, we’ve already identified several barriers to payment reform for population health, including:

  • multiple definitions of population health;
  • the complexity of how various payment models can impact social determinants of health;
  • misalignment of financial incentives;
  • lack of appropriate data;
  • lack of adequate outcomes measures;
  • insufficient evidence for which population health initiatives might have the greatest impact;
  • inability to replicate and scale innovations across various communities; and
  • the lack of a business case or return-on-investment for such activities.

Next steps include digging deeper into these challenges and working to identify and disseminate promising solutions to overcome shared challenges.

Stay tuned here, at the AcademyHealth blog, for updates on our initiative’s progress and emerging findings. If you are doing related work, please contact Enrique Martinez-Vidal; we’d like to include you in our efforts!

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