Financing that Rewards Better Health and Well-Being
Efficiency, effectiveness, equity, and experience implications of integrated payments for health
The COVID-19 pandemic has highlighted the urgent need to transform our current model of health care financing from a system that rewards the volume of services to one that incentivizes real improvements in personal and population health. Despite some progress in recent years, the financial well-being of the health care system is still heavily dependent on the volume and utilization of health care services paid by fee-for-service payments. Shutting down elective surgeries temporarily dealt the health care system a deep financial blow, leading to a loss of 1.4 million health care jobs just in the month of April 2020 and triggering calls for additional emergency funding for hospitals. The fragility of our health care system has never been on such clear display, and the need for practice and payment reform has never been greater. At the same time, not all care delivery systems experienced the same financial hardships due to the decrease in patient visits because of the pandemic. How can we enhance integrated payment models that deliver whole-person health care to a community, as these models fared the best in terms of finances and patient care during the pandemic?
To inform this work, the NAM Leadership Consortium convened a planning committee of experts to host a three-day symposium focused on accelerating movement away from fee-for-service and toward integrated payment approaches and author a NAM Special Publication identifying priority action areas for financing whole person, whole population health. In 2023, the NAM hosted three stakeholder-specific follow-on meetings focused on identifying implementation barriers and solutions to take tangible steps forward.
The United States is experiencing a decline in life expectancy despite high health care spending due to a multitude of factors, including the COVID-19 pandemic, opioid epidemic, high burden of chronic disease, and systemic and structural inequities.
A response proportional to this crisis is required. Valuing America’s Health: Aligning Financing to Reward Better Health and Well-Being explores opportunities to transform the current health and health care system to one that promotes whole person and whole population health. The publication emphasizes the need for a bold vision and sustainable financing strategies to prioritize health and well-being for all. Authors of the publication highlight the importance of building a movement to prioritize health, repairing systemic failures, holding stakeholders accountable, controlling health care costs, incentivizing health promotion, adopting collaborative financing and policy-making approaches, and empowering individuals and communities in health decision-making.
The way is clear; what is needed now is the will to move forward. Learn more about how to ensure our nation’s health and health care system can support optimal health for all.
Resource for State-based Financing Programs
A new resource from the NAM’s initiative on Financing that Rewards Better Health and Well-Being offers strategic insights and action steps for states and localities. These priorities include best practices that accelerate the movement from fee-for-service health care towards those that reward whole-person and whole-population health.
View the Interactive Resource
How can global payments help finance the delivery of high-quality, whole-person health care to improve population health? View a NEW interactive resource from the National Academy of Medicine and the NASEM Board on Health Care Services today.
Proceedings of a Workshop–in Brief
There is a need to transform the United States’ current model of health care financing – which rewards the volume of services provided – to a model that incentivizes integrated payment approaches that are person-centered and holistic in advancing individual, community, and population health.
The National Academy of Medicine Leadership Consortium and the National Academies of Sciences, Engineering, and Medicine’s Board on Health Care Services hosted a virtual workshop series titled Financing That Rewards Better Health and Well-Being in May and June of 2021. Speakers and discussions focused on identifying examples of care delivery and payment models that are focused on patient outcomes and advancing health equity, considering barriers and opportunities to scaling effective integrated payment models and approaches, and discussing strategies for transforming health financing to improve equity and individual and population health. This Proceedings of a Workshop-in Brief summarizes the discussions that occurred throughout the workshop series.
Workshop Dates and Times:
- Workshop Day 1: Envisioning an Integrated Health Care Delivery and Financing System | May 25, 2021 | 2:00 pm – 5:30 pm ET
- Workshop Day 2: Levers Underscored during the COVID-19 Pandemic | May 28, 2021 | 1:00 pm – 4:30 pm ET
- Workshop Day 3: Roadmap for Integrated Payment Approaches to Efficiency, Effectiveness, and Equity | June 2, 2021 | 2:00 pm – 5:30 pm ET
- Follow-on Workshop: State Innovations Leading the Way | November 16, 2021 | 12:00 PM – 3:30 PM ET
Where: Via webinar
In this workshop series, the National Academy of Medicine (NAM) explored how to transform fee-for-service health financing approaches into integrated payment approaches designed to drive attention and incentives toward delivery models that are person-centered and holistic. The delivery models focused on the advancement of individual, community, and population health by examining the advantages and complexities of effective and efficient financing through the lens of access, quality, coverage, and equity, as experienced during the COVID-19 pandemic.
The discussion will look to address five objectives:
- Describe the deficiencies in our current health delivery and financing systems for creating health and sustaining health care delivery in light of the COVID-19 pandemic.
- Identify and describe alternative payment models demonstrating major transformations in health care delivery and financing, address those deficiencies, and summarize their characteristics and designs.
- Describe how integrated financing approaches can be used to redirect payment for individual services that may be unnecessary or even harmful toward payment for care of the whole person, equitable population health outcomes, improved patient and provider experience, and reduced per capita costs.
- Evaluate how care models using integrated financing have adapted to the COVID-19 pandemic to create whole person-population health and remain financially viable.
- Identify practical strategies and financing approaches that effectively reward whole person-population health.
Day 1 of the workshop series focused on envisioning an integrated health care delivery and financing system.
Day 2 of the workshop series focused on examining innovative models and levers underscored during the COVID-19 pandemic.
Day 3 of the workshop series focused on a roadmap for integrated payment approaches to efficiency, effectiveness, and equity.
Workshop Planning Committee
- Kisha Davis, Aledade
- Hoangmai Pham, Institute for Exceptional Care
- Andrew Bindman, Kaiser Foundation Health Plan, Inc. and Hospitals
- Steven Cha,Office of the Secretary, Health and Human Services
- Margaret Chesney, University of California, San Francisco School of Medicine
- Deena Chisolm, Nationwide Children’s Hospital
- Christopher F. Koller, Milbank Memorial Fund
- Peter Long, Blue Shield of California
- Joshua Sharfstein, Johns Hopkins Bloomberg School of Public Health
- Sarah Szanton, Johns Hopkins Bloomberg School of Public Health