An important objective that has, unfortunately taken on a life of its own and has outlasted its utility and value. I don’t have the answer. I do have an opinion, don’t conflate quality with payment incentives. Quality is a floor and providers who don’t demonstrate sufficient initial quality should be curated out — think about the “just ok commercials” . It is a threshold issue.
I also think that quality and cost performance often go hand in hand … so providers who seek to be paid for value need to provide quality to the market and manage costs — direct costs and those of the that patients experience tied to outcomes and fragmented delivery. Retention and some informed version of a Net Promoter Score, with a dash of meaningful transparency may be possible alternatives? Outcomes that are meaningful to patients and consumers are required and the technical measurement of clinical quality and related paper (and coding) chase should be de-emphasized or made obsolete by secondary data collection of existing resources – like EMRs. These can and should be used by providers to improve their performance.