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NBCH Supports Government Leadership in Value-Based Physician Pay for Performance
The National Business Coalition on Health (NBCH) strongly believes that the key to the success of value-based physician pay for performance is the commitment to continuous quality improvement, standardized assessment of performance, the delivery of evidenced-based care and the reward of performance improvement.


Congress and the Centers for Medicare and Medicaid (CMS) are considering a number of strategies in the 109th session to integrate value-based purchasing into the Medicare program, though it is yet to be determined whether this action will result in incremental demonstration programs or if fundamental reform of the current Medicare provider reimbursement process will take place. Both purchasers and providers recognize that the current Medicare payment system needs to be updated. No longer can or should our nation's largest single purchaser of health care services enable an inefficient system which is based on an antiquated regulatory pricing system.


NBCH believes that fundamental change is absolutely vital this year and recommends that Congress and CMS work together to provide the leadership necessary to set a new and constructive precedent toward long-term reform. The most appropriate initial step in this process is the development of national consensus measures, followed by an incremental integration process allowing a proportion of provider's Medicare reimbursement to be performance-based. Overtures and dalliances toward ongoing demonstration projects and quasi-reform are no longer acceptable, particularly given the unsustainable cost and growth of health care services. Our government needs to make a firmer commitment toward long-term, effective reform.


Parallel to government's efforts, NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers. In developing, identifying and disseminating best practices in value-based purchasing strategies; NBCH seeks to accelerate the nation's progress towards safe, efficient, high quality health care.


NBCH is a national, non-profit, membership association of business health coalitions committed to reforming the health care system and improving community health through value-based purchasing. NBCH's membership consists of nearly 80 employer-based health care coalitions dedicated to value-based purchasing of health care services. Representing more than 10,000 employers and approximately 20 million employees and their dependents, NBCH's member business coalitions are composed of mostly mid- and large-sized employers in both the private and public sectors across the United States.


As the catalyst for value-based purchasing, for over a decade NBCH has been focused on a clear set of principles:

  • Value-based health care purchasing obtaining the highest quality care at the most reasonable cost
  • Measuring the comparative quality and efficiency of hospitals, physicians, and health plans in the community to identify the best value
  • Creating incentives to provide higher-value care through integrated delivery systems and continuous quality improvement
  • Improving the overall health of the community

The Role of Medicare in Value-Based Purchasing

NBCH and our members commend Medicare for taking a leadership role in provider pay for performance. As the nation's largest health care purchaser, Medicare has an opportunity to set an example to the private sector, and is in a very unique position to have the most influence on building the business case for quality. Additionally, to the degree possible, Medicare and private sector pay for performance activities need to be coordinated. A fine example of such collaboration is a Medicare pilot program in Arkansas in which physicians will be paid a bonus for investing and using health information technology (HIT). Similarly, NBCH's member coalition in Arkansas is participating in a pay for performance project that comprises a bonus for physicians investing in HIT who have been certified through NCQA's physician recognition program.


Key to the success of a performance-based health care provider payment system is a standardized set of national consensus measures. Consistency and reliability are vital to the success of performance-based health care. These measures should be used as a platform for all private and public sector performance programs, with preference given to measures endorsed by the National Quality Forum (NQF), and independent and national accreditation entities.


Finally, in addition to the development of national measures, we hope that as Congress works to address the Medicare physician reimbursement issue that considerable focus will be given to the basic principle of differential payment based on objective measures. We believe that timely development of this basic principle is the overriding responsibility of Congress while relegating to the Secretary of the Department of Health and Human Services (HHS) the authority to develop the processes for implementation of a Medicare provider differential payment system.