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Making the Business Case for Payment and Delivery Reform

How do you build the business case to overcome the barriers and elicit support for changes in how health care is delivered and paid for? Three groups — the Network for Regional Healthcare Improvement, Center for Healthcare Quality and Payment Reform, and Robert Wood Johnson Foundation — have published a guide to help.

Ten steps for making the case are presented:

  1. Define the planned change and expected results
  2. Estimate how the type and volume of services will change
  3. Determine how payments/revenues will change
  4. Determine how service costs will change
  5. Calculate the changes in provider operating margins
  6. Identify the changes in payment needed to maintain positive financial margins for providers
  7. Determine if a business case exists for both providers and purchasers
  8. Refine the changes to improve the business case
  9. Analyze the potential impact of deviations from the planned care and outcomes
  10. Design a payment model that pays adequately, assures wanted outcomes, and controls risk and variation

Details and examples are provided for each step. Data on billing/claims, clinical health records/registries analysis, service costs, and patient-reported outcomes will be needed for the analysis.

Source: Miller HD. Making the business case for payment and delivery reform. Network for Regional Healthcare Improvement, Feb. 24, 2014. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf411117

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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