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Mylia Christensen is executive director of HealthInsight Oregon and of the Oregon Health Care Quality Corporation (Q Corp). She was appointed to lead HealthInsight Oregon in July 2016 and has led Q Corp since 2010. Mylia has worked in almost all facets of health care, from clinical settings to hospital and health care system management, strategic planning and administration. Among other assignments before joining Q Corp, she served as project director for the Medicaid Evidence-based Decisions Project at Oregon Health & Science University’s Center for Evidence-based Policy; administrator of the State of Oregon’s Public Employees’ Benefit Board; director of program development and physician services for Legacy Portland Hospital System; and administrator of women’s health services at Good Samaritan Hospital. She began her health care career in emergency services and critical care nursing.

Toward a Multistakeholder Approach to Payment Reform


MACRA. QPP. MIPS. Value-based payment. If you feel lost in the sea of acronyms, reporting requirements and systems-level change, you aren't alone. Years of ongoing effort to transform the health care delivery system are now aligning with Medicare's commitment to paying for high-value care, and the change process seems dizzying at times.

Almost everyone agrees that the cost of health care is unsustainable and we must change the way we pay for care. Yet providers, health plans and other stakeholders face significant barriers as they strive to implement and sustain new payment models. System changes come with innumerable intricacies and nuances, including concerns about who wins and who loses. A major challenge is how to obtain and share reliable data to inform and test new models, and to reassure providers who are asked to accept accountability for improving quality while reducing cost. In the midst of these swirling changes, practices have to keep working hard to ensure high-quality care that satisfies their patients.

As I've worked in system change initiatives with multiple stakeholder groups over the years, I've noted all too often that stakeholders tend to work on addressing challenges within their individual spheres—be it a clinical practice, an organization or a network—even though adjustments in one part of the system have an impact on all others. Sustainable change depends on making all adjustments mesh effectively for all stakeholders.

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Total Cost of Care: A vital step toward payment reform

stethoscope and money

Constant change is the "new normal" in health care, and for me, some of the most exciting changes involve redesigning the way we pay for care. Recent federal legislation and Medicare program directives have aligned the monetary stars in favor of fundamental change in provider reimbursement, emphasizing health outcomes and value over volume of services.

Public and private payers, purchasers, providers and consumers all recognize that payment reform is essential to achieve better care at lower cost. First, though, we need more comprehensive quality and cost information to make the business case for change, enhance delivery systems and measure outcomes. At the core, we need reliable, transparent data about costs and their drivers.

That's why the Network for Regional Healthcare Improvement (NRHI) was so excited to receive funding from the Robert Wood Johnson Foundation (RWJF) for a multiregional pilot initiative focused on producing, sharing and using data on the Total Cost of Care (TCoC). This initiative, launched in November 2013, has developed a standardized approach to measuring and reporting the total cost of care and resource use across regions, and has created and tested a process for benchmarking multi-payer commercial health care costs.

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