Theory and Reality of Value-Based Purchasing: Lessons from the Pioneers

摘要

Employers are central figures in the current market-based health system. In theirpush to contain health care expenses, employers have been a driving force behind recent dramatic market changes: The move from indemnity coverage to managed care, the flurry of consolidations and mergers of health plans, the emergence of new risk-sharing and contracting patterns, and the slowdown in the rate of premium increase. More recently, some of the more forward-thinking employers have begun to use their market power as a force to promote quality and value of health care services as well. However, despite the undisputed role of employers in trying to shape the cost and content of health care, very little is known about why, how, or how well they exercise these powers, and we known even less about the impact of these purchaser activities on employees, employers themselves, and the broader health care market or community. The authors have a generation of research examining the behavior of physicians and hospitals, some more recent work on managed care organizations and health care systems, but very little systematic work on employers and purchasers of health care.