Essay on Alternative Payment Models in Health Care: AHQR Role in Development & Dissemination

Introduction

The majority of countries and health care institutions have in the recent past, been experimenting with alternative methods of payment in health care. These payment experiments are being conducted as an effort to try to improve health care services, control spending by the patients and raise accountability levels across the system of health care. The "Agency for Healthcare Research and Quality" (AHQR) plays a critical role in the development and dissemination of facts and evidence-based tools on the ways health care quality, effectiveness, efficiency and safety can be improved through digital health care strategies (Clancy, 2017).

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AHQR employs various Medicare sponsored initiatives that use monetary incentives to enhance the use or observance of medical practice guidelines. These initiatives include the following:

Private Sector Initiatives-California Pay for Performance Initiative

A considerable number of pay-for-performance programs in the private sector exist. One of the longest-running and most extensive pay-for-performance programs in the private sector is the California Pay for Performance Program (McDonald, & Roland, 2019). The program is overseen by the Association of Integrated Health, a not for profit and multi-stakeholder group aimed at accountability improvement, affordability and quality in health care.

The California Pay for Performance Initiative is positive in that; it has succeeded in using the promise of additional incentives in achieving high-quality performance in the health care industry. The success of this initiative is yielded from the fact that it focuses solely on measures that improve performance quality by medical practitioners and its transition to include measures that are based on values (McDonald, & Roland, 2019). Under the program, clinicians only receive budgets meant only for patient care rather than separate services and it contains pay-for-performance bonuses/rewards whenever quality targets are met.

The initiative was established in 2001 and has been active ever since. Since its establishment at the start of the century, the effort has been successful in its mission. It has succeeded in enhancing adherence and use of the set standards of practice by clinicians.

Public Sector Initiatives-Premier Hospital Quality Incentive

The program was established to evaluate the level to which bonuses improve the quality of service given to Medicare patients with conditions such as pneumonia, heart failure, and myocardial infarction (Ryan, 2019). Like any other pay-for-performance program, it narrowly focused on the quality of health services with very little or no consideration of cost.

The imitative was founded in 2003 and was active until 2009. During its six years of use, the incentive succeeded in promoting the use and adherence of clinical practice guidelines. In my personal opinion, the MACRA framework is feasible in ensuring widespread adoption of practice guidelines in health care. This is because such initiatives are put in place for every care provider to follow. Adherence or failure to follow these set practice guidelines has consequences. There are punishments and rewards set aside for those who fail to follow these practices and those who conform.

Conclusion

Specific initiatives must be put in place to improve health care services, control patient spending and increase accountability in the health care sector. AHQR has employed various Medicare initiatives that use incentives to improve health services. A considerable number of these programs have been successful in promoting the adoption and adherence of practice guidelines in health care.

References

Clancy, C. M. (2017). Patient safety and medical liability reform: putting the patient first. Rockville (MD): Agency for Healthcare Research and Quality.

https://www.psqh.com/analysis/september-october-201016/McDonald, R., & Roland, M. (2019). Pay for performance in primary care in England and California: comparison of unintended consequences. The Annals of Family Medicine, 7(2), 121-127.

http://www.annfammed.org/content/7/2/121.full.pdfRyan, A. M. (2019). Effects of the Premier Hospital Quality Incentive Demonstration on Medicare patient mortality and cost. Health services research, 44(3), 821-842.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699910/