Evaluating the Impact of Value-Based Purchasing: A Guide for Purchasers

As purchasers of much of the health care in the United States, employers could be a powerful force in closing the gap between the quality of care that we have and the quality of care we should have. Many employers are developing strategies aimed at improving the quality and value of the health care they purchase. However, we have little evidence on the impact of such efforts.

Employers and coalitions need tools to help them track and assess the impact of their efforts in "real time." That way, they can determine quickly what works best and how to fine-tune their strategies.

This guide was developed to be an evaluation tool for purchasers, particularly employers, in assessing their value-based purchasing activities. It was developed for a meeting sponsored by the Agency for Healthcare Research and Quality (AHRQ), "Understanding How Employers Can Be Catalysts for Quality: Insights for a Research Agenda," held April 4, 2001.

By Dennis P. Scanlon, Michael Chernew, and Hilary E. Doty

Contents

Acknowledgments
Preface
Introduction
Purpose of the Guide
Organization of the Guide
The Basics of Value-Based Purchasing
What Is Value-Based Purchasing?
Why Be a Value-Based Purchaser?
   Reason 1: To Improve Final Outcomes
   Reason 2: To Improve Intermediate Outcomes
What Do Value-Based Purchasers Do?
   Strategy 1: Change the Behavior and Decisions of Individuals
   Strategy 2: Change the Performance of Health Care Organizations and Practitioners
   A Goal Within Each Strategy: Reduce Imbalances in Information
Why Evaluate Value-Based Purchasing Activities?
Steps for Evaluating Value-Based Purchasing Activities
Step 1: Define Your Value-Based Purchasing Activieies and Their Goals
   First Challenge: Sorting Out Related Activities
   Second Challenge: Deciding What Matters
Step 2: Determine the Necessity, Appropriateness, and Feasibility of an Evaluation
   How Well Was the VBP Activity Implemented?
   How Strong a Relationship Do You Want To See?
   Is It Too Soon To See an Effect?
Step 3: Choose a Research Design To Assess the Impact of Value-Based Purchasing Activities
   Qualitative Research Designs
   Quantitative Research Designs
   How Do You Choose a Research Design?
Step 4: Implement the Research
   Task 1: Identify Appropriate Measures
   Task 2: Collect the Data
   Task 3: Analyze the Data
Step 5: Summarize the Results and Interpret Implications for Purchasing Activities
References
Selected Resources and Web Sites for Purchasers' Quality Improvement Activities
Bibliography

Tables
1. Examples in the Literature of Purchasers Engaged in Value-Based Purchasing
2. Examples of Value-Based Purchasing Activities and Outcomes

Figures
1. A Bird's-Eye View of Value-Based Purchasing Strategies
2. Cross-Sectional Design With No Comparison Group
3. Pretest/Posttest (or Before/After) Design
4. Cross-Sectional Design With Comparison Group
5. Nonequivalent Comparison Group
6. Time Series
7. Overall Network Commercial

AHRQ Publication No. 02-0029