Quality Management in Health Care
December 2012, Volume 21 Number 4 , p 213 - 219
Rising health care costs will result in reduced payments to providers, but across-the-board provider payment reductions are not the answer. Instead, existing payment systems should be reformed to strengthen value for the dollars spent. This can be accomplished by increasing efficiency, improving quality and outcomes, and lowering costs. Payment system reforms must be practical, transparent, identify opportunities for care improvement, and demonstrate material cost savings. Most importantly, because the current growth in health care costs is unsustainable, these reforms must be able to be implemented today. A set of comprehensive measures is being used by state government and private payers in the United States to adjust payment, based on improved outcomes quality. This article details the use of this set of measures, referred to as potentially preventable events, and demonstrates how they are being applied to achieve health care value.