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Toward a Multistakeholder Approach to Payment Reform


MACRA. QPP. MIPS. Value-based payment. If you feel lost in the sea of acronyms, reporting requirements and systems-level change, you aren't alone. Years of ongoing effort to transform the health care delivery system are now aligning with Medicare's commitment to paying for high-value care, and the change process seems dizzying at times.

Almost everyone agrees that the cost of health care is unsustainable and we must change the way we pay for care. Yet providers, health plans and other stakeholders face significant barriers as they strive to implement and sustain new payment models. System changes come with innumerable intricacies and nuances, including concerns about who wins and who loses. A major challenge is how to obtain and share reliable data to inform and test new models, and to reassure providers who are asked to accept accountability for improving quality while reducing cost. In the midst of these swirling changes, practices have to keep working hard to ensure high-quality care that satisfies their patients.

As I've worked in system change initiatives with multiple stakeholder groups over the years, I've noted all too often that stakeholders tend to work on addressing challenges within their individual spheres—be it a clinical practice, an organization or a network—even though adjustments in one part of the system have an impact on all others. Sustainable change depends on making all adjustments mesh effectively for all stakeholders.

In that spirit, Q Corp and the Oregon Medical Association last week hosted the Oregon MACRA Playbook Conference in Portland. This event brought together 227 health care professionals from Oregon health systems and independent practices to network and learn about the move toward value-based and alternative payment methodologies.

Speakers and panelists shared national, regional and local perspectives about the ins and outs of implementing value-based payment in different settings. My key takeaways included the following.

  1. This is all about managing change.
    • MACRA may feel overwhelming, but it's not going away. Practices should gear up to participate now while the stakes are low.
    • Change is personal. Many providers are experiencing or have the potential to experience burnout–but implementing team-based care can help!
  2. Data, technology and measurement are important considerations.
    • We have a pressing need to align payment models and clarify how they work together to support high-quality care.
    • Practices have data, but they need support to interpret and apply data to improve care and reduce costs.
    • Harmonizing measurement is a key to payment reform success.
    • At the core of payment reform, we need reliable, comprehensive, transparent data about health care costs and their drivers.
  3. A lot of resources are available to help.
    • HealthInsight offers no-cost assistance to practices in our four-state region. Interested practices can learn more at
    • Q Corp's payment reform resource library offers a wealth of free materials at
    • The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP) website at also provides access to a resource library and the latest QPP email updates.

I encourage you to review the materials from this event, including presentations and handouts, online at

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