AHRQ’s Health Care Innovations Exchange Focuses on Value-Based Reimbursement Structures
The latest issue of AHRQ’s Health Care Innovations Exchange features three programs that implemented value-based reimbursement policies at the state level. One profile describes a program that adjusted hospital payment rates based on specific performance metrics. Maryland’s Quality-Based Reimbursement (QBR) program adjusts individual hospital payment rates each year based on that hospital’s performance on a set of metrics in three areas: adherence to evidence-based care processes in four care domains (heart attack, heart failure, pneumonia, and surgical care), the patient care experience across eight dimensions of care, and overall risk-adjusted mortality. Worse-performing hospitals lose up to 0.5 percent of revenue, and better performers earn up to a similar amount. The QBR program has generated improvements in performance on all process-of-care measures, reduced variations in performance on these measures across hospitals, and served as a catalyst for cross-hospital efforts to boost Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, scores. Select to access more innovation profiles and tools related to value-based reimbursement on the Innovations Exchange Web site, which contains more than 775 searchable innovations and 1,525 quality tools.