In a paper published in the American Journal of Managed Care, Duke University’s Barak D. Richman, Nick Kitzman, and Kevin Schulman, along with Arnold Milstein of Stanford University, provide a new legal analysis based on common law principles that can prohibit balance billing at inflated prices.

However, the transition to new models is not easy. Published studies of payment reforms have shown mixed results, leaving providers, payers, purchasers, and patients uncertain about how to proceed.

There is a strong consensus among health care stakeholders about the need for better evidence on the impact of payment reforms. Better evidence would give providers and the public more confidence in implementing payment and delivery reforms—and also knowing which ones to avoid. Evaluations can help stakeholders identify where to make necessary changes. In short, better evidence would ensure that we realize the promise of payment reforms to improve care and reduce costs.

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