Seeking Consensus on the Terminology of Value-Based Transformation through use of a Delphi Process

Marilyn M. Schapira*, Meredith Williams, Alan Balch, Richard J. Baron, Patricia Barrett, Roy Beveridge, Tracie Collins, Susan C. Day, Rushika Fernandopulle, Anders M. Gilberg, Douglas E. Henley, Amy Nguyen Howell, Christine Laine, Christina Miller, Jaewon Ryu, Donald F. Schwarz, Mark D. Schwartz, Jeffrey Stevens, Elizabeth Teisberg, Ken YamaguchiEmily Schapira, Rebecca A. Hubbard

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Collaboration among diverse stakeholders involved in the value transformation of health care requires consistent use of terminology. The objective of this study was to reach consensus definitions for the terms value-based care, value-based payment, and population health. A modified Delphi process was conducted from February 2017 to July 2017. An in-person panel meeting was followed by 3 rounds of surveys. Panelists anonymously rated individual components of definitions and full definitions on a 9-point Likert scale. Definitions were modified in an iterative process based on results of each survey round. Participants were a panel of 18 national leaders representing population health, health care delivery, academic medicine, payers, patient advocacy, and health care foundations. Main measures were survey ratings of definition components and definitions. At the conclusion of round 3, consensus was reached on the following definition for value-based payment, with 13 of 18 panelists (72.2%) assigning a high rating (7-9) and 1 of 18 (5.6%) assigning a low rating (1-3): "Value-based payment aligns reimbursement with achievement of value-based care (health outcomes/cost) in a defined population with providers held accountable for achieving financial goals and health outcomes. Value-based payment encourages optimal care delivery, including coordination across healthcare disciplines and between the health care system and community resources, to improve health outcomes, for both individuals and populations." The iterative process elucidated specific areas of agreement and disagreement for value-based care and population health but did not reach consensus. Policy makers cannot assume uniform interpretation of other concepts underlying health care reform efforts.

Original languageEnglish (US)
Pages (from-to)243-255
Number of pages13
JournalPopulation Health Management
Issue number3
StatePublished - Jun 1 2020


  • delphi technique
  • health care reform
  • health policy
  • population health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy
  • Leadership and Management


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