Some new payment arrangements since the creation of the Center for Medicare and Medicaid Innovation have benefits, but not all (JAMA Health Forum. 2020. doi:10.1001/jamahealthforum.2020.1323).
“To ensure that these results inform future policy agendas, policy makers can apply the principle of policy equipoise to existing evidence,” wrote Jonathan Staloff, MD, MSc, University of Washington, Seattle, and colleagues. “Policy equipoise will help prioritize which payment models to test and when to do it using randomized designs to generate rigorous evidence.”
Modeled after the concept of policy equipoise in clinical medicine, 2 prominent payment arrangements are used to demonstrate beneficial effects of implementing policy equipoise to payment model evaluation. The two arrangements are pay for performance (absence of policy equipoise) and population-based payment (presence of policy equipoise).
Pay for performance has been the cornerstone of payment reform, but strong data supporting this arrangement are lacking. In addition, the benefit of pay for performance can vary in many settings.
Comprehensive population-based payment models apply policy equipoise and requires providers to be accountable for the quality and costs of care across patient populations. Policy equipoise allows for population-based models to be tested against fee-for-service and with other payment models. It also helps policy makers prioritize and justify randomized trials.
“To be fair, well-conducted randomized trials are not costless, requiring policy makers to provide adequate administrative support and partner with researchers on trial design choices,” concluded Dr Staloff and colleagues. “Nonetheless, we should strive to use policy equipoise to set our payment agenda—efforts that would help our country effectively reboot value-based payment after COVID-19.”—Lisa Kuhns
