Paying for Quality and Coordination: Aligning Provider Payments With Global Goals

Abstract

Policy reform is increasingly focused on the interrelated goals of improving care quality and increasing efficiency through provider coordination. Proposals must address 2 central issues: How to apportion stakeholder accountability and how to measure increased value (returns for resources spent). This article argues that incentives can be created for increasing coordination by specifying accountability for the 4 basic types of health care encounter defined in this article. Payment design can be used to identify units of service that are sufficiently narrow to give a transparent understanding of the type of care rendered but with the capacity for aggregation to describe the process as a whole. Transparency is defined as the use of categorical or rules-based models such as Diagnosis Related Groups. Payment systems can use a building block approach for each of the 4 types of health care encounter so as to encourage improved coordination of health care services.