Shaping Payment Reform

What can be learned from AF4Q Alliances’ experience in developing and implementing payment reform projects? Value-enhancing payment methods are necessary for high-value care, and successful payment reform methods reward, promote, and sustain improvement. Two of the Alliances’ goals were to increase value (improved quality and lower cost) through outcome-focused payment reform and to reduce health care costs and spending in order to promote high-value health care. Payment reform in the context of AF4Q is unique because of the program’s set geographic range. Traditional payment reform occurs within one setting—in a health system, for example—rather than across a community. This defining feature of AF4Q payment reform work has resulted in both challenges and success stories, described here.



This brief addresses the successes and challenges encountered in a recent bundled payment pilot project in Wisconsin, as well as the underlying transformative effects on patient care.

The Market Assessment tool, with testing and refinements, has the potential to be used broadly and help many regional markets identify their key attributes and how those will affect the payment reform options they are considering.

This is the third in a series of annual issue briefs that have tracked the development and implementation of bundled payments in the public and private sectors.  This brief builds upon the two previous issue briefs by providing a more in-depth review of the operational steps health plans and providers are taking to be successful under bundled payment.