Central to the nation’s health care reform agenda is the principle of value-based reform – restructuring provider payment incentives to control volume growth and to optimize efficiency, quality and access. Four value-based payment methodologies are currently receiving considerable attention from the Centers for Medicare & Medicaid Services (CMS) and the Medicare Payment Advisory Commission (MedPAC), and may shape physician reimbursement in the near future: bundled payments, gainsharing, the use of the medical home to coordinate care, and pay-for-performance arrangements. This month, bundled payment pilots are being launched around the country. …

As physicians, hospitals and payors continue to ramp up their efforts to reduce preventable adverse medical events, relatively little attention has been paid to a moment in the care process when the patient is particularly vulnerable: the hospital discharge.

Moving to the ICD-10 code sets may be the most complex change for the U.S. health care delivery system in decades, requiring massive system and workflow changes, including coordinated actions among medical groups, their vendors and health plans.

Physicians play a central role: helping the patient redefine success. Encouraging overweight and obese patients to sustain a modest, but realistic weight loss of only a few pounds can bring significant health improvement even in the absence of much cosmetic change.

The health care overhaul debate appears to have moved beyond how to expand health insurance to cover all Americans and how to reduce health care spending, as two separate questions. The focus now is working out details of how to structure incentives appropriately to optimize cost, quality and access.