The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis to advance state health leadership, strong primary care, and sustainable health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest blogs from our thought leaders, including Fund President Christopher F. Koller.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a foundation that works to improve population health and health equity.
The Future of Population Health (Volume 101)
Quarterly Article
Kushal T. Kadakia
Anaeze C. Offodile
Kadakia KT, Offodile AC. The Next Generation of Payment Reforms for Population Health – An Actionable Agenda for 2035 Informed by Past Gains and Ongoing Lessons. Milbank Q. 2023;101(S1): 866-892.
September 2024
March 2024
Back to The Milbank Quarterly
Policy Points:
The American paradox of spending a disproportionately greater share of the country’s gross domestic product on health care without achieving commensurate improvements in care quality or outcomes has long rendered the United States an outlier in comparison to other high-income countries.1 Although the economic shock of the COVID-19 pandemic induced a temporary deceleration in spending growth, national health expenditures in the United States still exceeded $4.3 trillion in 2021, and are projected by the Centers for Medicare & Medicaid Services (CMS) to reach $6.3 trillion by 2030.2 Other countries around the world are also grappling with the challenge of curtailing spending, which in both the United States and abroad can be attributed to a number of factors including the evolving burden of chronic diseases, the aging population, and the cost of new medical technologies. However, US health care spending remains aberrant even after accounting for these factors, from substantial added costs arising from administrative waste and unnecessary service provision to fragmented care and incentive misalignment.3
These excess expenditures also reflect a fundamental flaw in how resources are allocated across the American health care system. For example, the United States spends three times as much on wasteful administrative complexity as it does on the entirety of federal, state, and local public health.4 Likewise, the literature on low-value care—which accounts for nearly $100 billion in wasteful spending—should be considered alongside emerging evidence about the under-provision of high-value care, with many high-risk patients often lacking access to clinically appropriate diagnostics and therapeutics.5 Resource misallocation not only exacerbates financial strain for payers, employers, and families, but also contributes to longstanding inequities in health care organization and delivery exemplified by worse access and outcomes for racial and ethnic minorities and low-income populations.6,7
To address these challenges, US health care reform over the past decade has placed substantial focus on rewiring health care financing, specifically increasing provider accountability for utilization (i.e., cost) and/or outcomes. Previous legislation and administrative action sought to slow spending by regulating either the quantity (e.g., the so-called “managed care revolution” of the 1990s) or the price (e.g., Medicare’s Sustainable Growth Rate, which was repealed in 2015) of health care services.8 However, these approaches often focused disproportionately on moderating costs over improving outcomes, and also lacked the broad stakeholder support that is necessary to achieve durable change. Instead, with the passage of the Affordable Care Act (ACA) in 2010, lawmakers sought to promote policies focused on marrying the goals of payment reforms (lower costs) and delivery system transformation (better quality and outcomes).