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Payment Reform

The early months of the COVID-19 pandemic underscored the crippling defects of fee-for-service reimbursement long used to pay most health care providers in the United States. As the volume of clinical office visits and elective procedures collapsed, provider revenue plummeted, placing a large percentage of health care providers at risk of closing their doors. Fee-for-service payment also rewards volume over quality and does little to encourage more efficient care or accountability the quality of services provided.

PBGH pursues a range of payment model demonstrations acting as a trusted third-party convening health plans, providers and employers to create consensus around alternative payment models that lower costs and improve care quality.

Initiatives


Value-Based Contracting

PBGH works on multiple fronts to accelerate adoption of high-value health care delivery and payment models through policy advocacy, education and purchaser engagement.

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Bundle Design

Bundled payments for episodes of care have proven to be a powerful method for encouraging greater use of high-value health care services and discouraging use of low-value services.

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Payment Reform and Quality Improvement

PBGH works with policymakers to advance the development and application of alternative payment models that hold providers accountable for quality of care.

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National Health Plan Playbook

A first-of-its-kind tool backed by the purchasing power of more than two dozen large employers, the Health Plan Playbook allows purchasers to influence health plan spending decisions in support of higher-value, more equitable care.

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Primary Care Payment Reform Workgroup

The PBGH National Primary Care Payment Reform work group, comprised of large employers and convenes purchasers and other stakeholders to build consensus for new payment models that support and enable advanced primary care.

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