If health care purchasers are the key to health care reform (see George Halvorson’s remarks), the nation’s biggest health care purchaser, Centers for Medicare and Medicaid Services, is the purchaser to watch.

There the focus is on value-based purchasing, in which CMS reverses a 40-year tradition and finally starts paying for quality and efficiency.

The main message from Thomas Valuck, MD, JD, senior adviser, Center for Medicare Management, Centers for Medicare & Medicaid Services, is that CMS is in the value-based game to stay, thanks to Executive Order 13410. The going seems slow (especially considering the Medicare Trust Fund is currently expected to be depleted in 11 years….) but the list of initiatives under way is long and somewhat impressive.

Until you hear Dr. John Toussaint, president and CEO of ThedaCare, a Wisconsin health system, who pointed out that CMS’ process-oriented measurement is ineffective and cumbersome and that true value-based purchasing is not happening. Indeed, hospitals that offer low-cost, high-quality care are frequently penalized financially for their efforts. Read more about Toussaint’s presentation here later.

In the meantime, you can track of CMS’ thinking on value based purchasing by watching:

• Institute of Medicine Payment Incentives Report

Look for three-part series: Pathways to Quality Health Care

• MedPAC

–See ongoing studies and recommendations regarding value-based purchasing tools

• Congress

–Expect new value based purchasing tools in this year’s Medicare bill

• CMS Proposed Regulations

–Seeking public comment on the VBP building blocks

• CMS Demonstrations and Pilots

–Check out periodic evaluations and opportunities to participate

• CMS Implementation of MMA, DRA, and TRHCA provisions

–Demos, P4R programs, VBP planning