2010 Call for Proposals Brief Proposal Deadline October 20, 2010

Payment Reform for High-Value Care

Background Health care in America is uneven and often of poor quality even though we spend more on care than any other nation. The way we pay for care is a major underlying, contributing cause of this poor health care quality and value. Generally, our current payment systems provide powerful incentives for delivering more services to more people. Paying for more care rather than better care, in turn, fuels the growth in health care costs but does not necessarily promote higher quality or value. Current payment schemes also too often inhibit efforts to improve care. Ultimately, payment methods must change in ways that reward high value rather than high volume. In order to drive high-value care, payment methods must reward, promote and sustain improvements in the quality and cost of care. At the same time, although improved payment systems hold significant promise for improving the value of health care, fundamental payment reforms are inherently complicated and risky. Their success depends on many interconnected pieces of the market and multiple interested stakeholders. There are also multiple interconnected opportunities for failure. Nevertheless, value-enhancing payment methods are necessary for high-value care. The recently enacted Patient Protection and Affordable Care Act includes a variety of provisions aimed at stimulating payment and delivery system reforms, precisely for these reasons. Those new federal payment experiments will unfold over the next several years. These payment efforts will focus primarily on Medicare and to a certain extent Medicaid. The Robert Wood Johnson Foundation (RWJF) is hoping to stimulate locally-based, complementary, payment experimentation with this solicitation and related offerings. Payment changes likely depend fundamentally on aspects of a given health care market like: better and widely shared performance information, consumer and purchaser ability to demand high quality, and resources that support improvements in care. At the same time, although improved payment systems hold significant promise for improving the quality, cost and value of health care, there are a number of important issues and questions that need to be addressed and a variety of challenges that need to be overcome before anyone can credibly reform payment. Purpose RWJF seeks to fund innovative proposals for payment reform efforts designed to promote high-value health care outcomes that leverage existing market knowledge, partnerships and resources. These funds will not support extensions of existing pay-for-performance (P4P) efforts or implementation of generic medical home demonstrations. We would, however, consider funding for P4P efforts or medical home demonstrations that are linked with outcome-based performance payments. For example, a payment incentive program based on reducing hospital readmission rates for chronic disease patients might be an appropriate place to start for a given group or community and could be built around a P4P or medical home effort. Applicants may propose a multistakeholder payment strategy or a payment reform experiment that pertains to a limited care dyad or triad of, for instance, health plan, employer and health care provider. Payment reform experiments and strategies are complicated and challenging; nevertheless, applicants should be as bold as possible in
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Key Dates and Deadlines

October 20, 2010 (3 p.m. ET) Early December 2010

Deadline for receipt of brief proposals.

Applicants notified if invited to submit a full proposal.

February 2, 2011 (3 p.m. ET)

Deadline for receipt of full proposals.

Inquiries
Inquiries may be directed to payment-reform@rwjf.org.

www.rwjf.org/cfp/qe5

For more information about funding opportunities from the Robert Wood Johnson Foundation visit www.rwjf.org/grants. Sign up to receive e-mail alerts on upcoming calls for proposals at http://my.rwjf.org.

the proposed payment reform activity. Proposals and strategies that highlight creative, pragmatic, opportunistic approaches will be stronger proposals than those that do not. In developing and describing their payment reform activities or market payment reform strategies, applicants should ensure that the activity or strategy explicitly describes the respective payers who will participate and how they will participate. If invited to submit a final proposal, applicants must include written statements of commitment from those relevant payers. Successful projects will describe: a. Existing activities. Describe the kinds of payment reform planned or already started. These activities might include local payment summits; payment pilots sponsored by health plans, health systems or others; and participation in state-wide or larger efforts. b. Proposed activities. Indicate whether applicant will either: a) plan and develop a new payment reform strategy, if none now exists; or b) plan, execute or build substantially on existing payment efforts. c. Important aspects of proposed payment plan or implementation activities. Describe the following:

Project Focus Describe the condition or procedure or set of conditions and procedures that will be the focus of the payment reform effort. Describe the desired actual types or range of cost and quality outcomes and the types or range of payment reform activities that need to happen in order to achieve those outcomes. Detail how the project will document the impacts of the effort on both cost and quality preferably in a value calculation to improve quality and lower or manage costs, gain experience with care improvements that support payment changes, and develop and test administration systems. Link strategy with other relevant efforts including, for instance, federally-funded or state-funded payment reform efforts, as appropriate or possible. Incorporate relevant measures of costs, quality, implementation costs and unintended consequences. Market and Commitments If invited for a full proposal, include an explicit written commitment from the participating payers that will be involved in the payment reform strategy. Approximate the portion of total market health care expenditures impacted by the targeted health care conditions. Approximate the number of physicians or other health professionals involved in the payment project. Barriers Describe the significant technical and other barriers to the suggested payment strategy and how that payment work might overcome these kinds of barriers.

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Evaluation Work toward real-world testing to generate practical business models, in addition to potential peer-reviewed scientific tests. Indicate commitment to help inform or assist other related payment reform projects and to participate in a formal evaluation of this payment effort. Timelines and Deliverables Include a timeline for key activities, milestones and important deliverables. Specifically note whether deliverables will likely include piloting of new payment models during this grant period.

Total Awards

A maximum of three grants of between $50,000 and $300,000 each will be awarded for up to 36 months each. Up to $300,000 in total will be awarded in this solicitation. Eligibility Criteria Applicants must be based in the United States or its territories and may be either public entities or nonprofit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code. Selection Criteria Proposals will be selected on the basis of the following: Fit with the topics described in this solicitation. Efforts that make unique contributions to learning about implementing payment reforms that support high-value care. Feasibility including evidence of commitment from payers and other relevant stakeholders. Scope and potential impact of the payment project. Generalizability. Use of Grant Funds Grant funds may be used for project staff salaries, consultant fees, data collection and analysis, meetings, supplies, project-related travel, and other direct project expenses, including a limited amount of equipment essential to the project. In keeping with RWJF policy, grant funds may not be used to subsidize individuals for the costs of their health care, to support clinical trials of unapproved drugs or devices, to construct or renovate facilities, for lobbying, or as a substitute for funds currently being used to support similar activities. Evaluation RWJF will support an independent research team to evaluate these payment projects. As a condition of accepting RWJF funds, grantees must participate in the evaluation. Grantee participation includes assisting with necessary data collection to accomplish the evaluation objectives. These data collection efforts may include interviews with key stakeholders, phone or mail surveys, document collection and analysis and participation in key meetings.
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How to Apply There are two stages in the competitive proposal process: (1) applicants submit a brief proposal that describes the project and; if invited, 2) applicants then submit a full proposal, written commitments from participating payers, budget narrative and additional documentation. Stage 1: Brief Proposals Applicants must submit a brief proposal narrative of no more than four pages that describes the project and a one-page preliminary budget. Proposals for this solicitation must be submitted electronically. Visit www.rwjf.org/cfp/qe5 and use the Apply link for this solicitation. You will be required to register at MyRWJF before you begin the application process. Stage 2: Full Proposals Selected Stage 1 applicants will be invited by e-mail to submit a full proposal of no more than 10 pages accompanied by written statement of commitments by the participating payers as well as a line-item budget, budget narrative and additional documentation. For more information on the program and proposal requirements please contact us at payment-reform@rwjf.org. RWJF does not provide individual critiques of proposals submitted.

www.rwjf.org/cfp/qe5

2010 Robert Wood Johnson Foundation Quality/Equality September 2010