Value-Based Contracting

Health care’s legacy fee-for-service payment model encourages the delivery of volume while doing little to incentivize value or quality. Value-based payment models are changing this flawed dynamic to reward providers for quality and value and discourage unnecessary care. PBGH works on multiple fronts to accelerate adoption of high-value health care delivery and payment models through policy advocacy, education and purchaser engagement.

Specialty Care

Treating cancer and mental health issues and providing maternity services, among other types of specialty care, often result in high costs and uneven quality for both employers and their employees.

PBGH offers pioneering patient-reporting programs that track variations in care to help optimize patients’ treatments, and we work as a strategic and technical partner with large employers to expand payment models that encourage greater use of high-value specialty services.

Primary Care

Employers know that primary care is essential to a healthy workforce and employees’ access to a high-value health care system. Studies show that robust systems of primary care can lower overall health care utilization, disease and death rates and increase the use of preventive services. Strong primary care also may reduce the negative effects of income inequality and is associated with more effective and equitable health services.

Through a range of programs and initiatives, PBGH supports and advances a strong primary care system by incentivizing integrated and coordinated care that puts patients at the center.

Patient-Reported Outcomes — Mental Health

Patient-reported outcomes generate important information to help clinicians better deliver mental health treatment. They also enable patients to more actively participate in their own care.

PBGH has been selected to receive an PCORI Engagement Award, which will support our efforts to convene leading plans, providers and stakeholders with demonstrated success in implementing PHQ-9 screening and use of depression screening and remission measures for patient engagement, quality improvement and care redesign. By bringing together plans, purchasers, providers, consumers and policy makers, the project team will identify best practices and key research questions that address administrative challenges, perceived patient/provider burden and build consensus methods.

“Path Forward: Outcomes-based Mental Health Care” is part of a portfolio of projects that PCORI has funded to help develop a community of patients and other stakeholders equipped to participate as partners in comparative clinical effectiveness research (CER). In addressing myriad infrastructure issues and engaging stakeholders on outcomes reporting and using data for comparative effectiveness research, the team hopes to reinforce the value of integrating purchaser and consumer perspectives, and ultimately improve outcomes for depression and apply lessons to improving other behavioral health outcomes.

Separately, PBGH is collaborating with IHA to implement a depression screening measure across 20 Accountable Care Organizations (ACOs). The initiative is designed to demonstrate the benefits of integrating behavioral health and primary care. PBGH also is pursuing a similar project in Massachusetts in collaboration with Blue Cross Blue Shield Massachusetts.

Advanced Primary Care

Employers know that primary care is essential to a healthy workforce and employees’ access to a high-value health care system. Studies show that robust systems of primary care can lower overall health care utilization, disease and death rates and increase the use of preventive services.

That’s why PBGH has developed a set of advanced primary care attributes used by payers, providers and health care purchasers to incentivize high-quality, lower-cost primary care with patients at the center of every interaction. We are working to scale high-quality primary care through the development of a national network that is vetted to include a region’s highest performing primary and specialty care practices.

PBGH’s approach to advanced primary care redirects existing health care spend to high-quality, equitable and evidence-based care while holding total cost flat.