Budget criteria and drug value assessments: a case of apples and oranges?

Health Affairs Blog

22 September 2016 - Last year, the US Department of Health and Human Services announced a historic initiative to shift Medicare’s reimbursement paradigm. Instead of paying for the “volume” of care, Medicare would now aim to pay for “value.”

Medicare’s announcement coincided with renewed interest in the private sector in finding new ways to align prices with value in health care. Both private payers and delivery systems have begun to embrace the possibilities of innovative pricing arrangements for pharmaceuticals and of rewarding quality throughout health care. Experiments with bundled payments and other innovative pricing approaches continue to gather momentum. Nearly all market participants share the goal of reducing spending on low-value care strategies and shifting it towards higher-value uses.

Health technology assessment will likely play an integral role in health care’s paradigm shift. We cannot reward value until we properly measure it. While the details of value measurement continue to be vigorously debated, nearly unprecedented consensus has emerged over the need to align reimbursement and utilization with value.

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Michael Wonder

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Michael Wonder