Marina A. Milad, Accenture, Chicago, Illinois.
Roslyn C. Murray, University of Michigan, Ann Arbor, Michigan.
Health Aff (Millwood). 2022 Apr;41(4):540-548. doi: 10.1377/hlthaff.2021.01020.
Value-based payment models are a prominent strategy in health reform. Although Medicare payment models have been extensively evaluated, much less is known about value-based payment models in the commercial insurance sector. We performed the first systematic review of the quality, spending, and utilization effects of commercial models, extracting results from fifty-nine studies. Forty-one of these studies evaluated outcomes. More studies had positive results for quality outcomes (81 percent of studies) than for spending (56 percent) and utilization (58 percent). Less rigorous studies were more likely to find positive results. Given the mixed nature of the findings, commercial insurers should identify ways to strengthen value-based payment programs or leverage other strategies to improve health care value.
基于价值的支付模式是医疗改革的一个突出策略。尽管医疗保险支付模式已经得到了广泛的评估，但商业保险领域基于价值的支付模式的情况却知之甚少。我们对商业模式的质量、支出和利用效果进行了首次系统评价，从 59 项研究中提取了结果。其中 41 项研究评估了结果。在质量结果方面，更多的研究有积极的结果（81%的研究），而在支出（56%）和利用率（58%）方面则较少。更不严格的研究更有可能得出积极的结果。鉴于研究结果的性质复杂，商业保险公司应该找到加强基于价值的支付计划或利用其他策略来提高医疗保健价值的方法。
