4.Y.1. PechaKucha: Value based payments: do they deliver on their promises? Recent experiences in Europe and Canada

Abstract Background Healthcare spending in Europe has steadily increased, often without corresponding gains in value. In response to financial pressures, countries have sought to improve value either by reducing unnecessary costs or by increasing productivity or quality of care. One common strategy for this objective has been to replace input-based payments with “value-based” payments (VBP). Definitions of VBP vary, but VBP models typically bundle payments across episodes of care, chronic conditions, or patient populations across several providers. VBPs intend to shift financial risk from payers to providers, holding the latter accountable for the cost and quality of care delivered. They are designed to foster coordination among providers, and adopt a broader view of value, including care integration, cost reduction, and site optimization, and consider social risk factors to promote equity. Their strength lies in moving away from micromanagement, enabling providers across settings to collaborate flexibly. However, VBPs are not new, and evidence shows modest or no improvements in efficiency and quality, with varying impacts on healthcare spending, outcomes, and patient experience. Difficulties in adequately adjusting payments for patient and provider characteristics can result in risk selection and ‘gaming’ practices, undermining equity and quality. As a result, countries have increasingly refined VBP models to better manage risk and incentives, improve care coordination and increasingly involve patients in assessing quality of care, for example, by incorporating patient-reported outcome and experience measures (PROMs and PREMs). Objectives This workshop will present recent experiences with VBP models in Europe, highlighting their intended and unintended consequences. This discussion aims to inspire and inform other countries looking to design or (re)shape their own payment mechanisms. Format This will be an interactive session and engage the audience. 1. The first presentation will define and characterize VBP, highlighting examples across six countries. Three case studies will showcase how different VBP models tackle previous limitations: 2. Article 51 promotes innovations in the French health system. Three pilots will be presented, including “coordinated care pathways” and capitation, that bundle payments for primary care across providers to integrate care; and pay for performance add-ons to promote quality of care. 3. The German “Quality contracts” aim to foster provider competition based on quality, and account and pay hospitals for quality of care, inter alia, with PROMs as indicators. Yet, it does not always reduce costs. 4. An experiment in the Netherlands tackles this problem by unconventionally replacing fee-for-service by SES-risk-adjusted capitation for oral health. The aims are to reduce unnecessary treatment and costs, while also minimizing social inequalities. Key messages • While policies to reform payment mechanisms are usually relatively easy-to-implement, if they are not accompanied by other policy tools they are unlikely to achieve all intended objectives. • The implementation of VBPs can result in unintended consequences, which may be mitigated through careful design balancing the risks between payers and providers, while accounting for quality of care. Speakers/Panellists Maiwenn Meyer Caisse nationale de l’Assurance Maladie, Paris, France Yohan Wloczysiak Caisse Nationale de l’Assurance Maladie, Paris, France Lukas Schöner TU Berlin, Berlin, Germany Stefan Listl Radboud University, Nijmegen, Netherlands

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