Payment Reform and Integrated Care
AMA Payment Model Resources @ http://www.ama-assn.org/ama/pub/about-ama/strategic-issues/payment-model-resources.page
Commonwealth Fund: Guterman, Developing Innovative Payment Approaches
PCPCC Payment Reform Brief March 2011
Rand reports – cataloging of 100 implemented and proposed payment reform programs and more.
A Health Plan Spurs Transformation of Pirmary Care Practices Into Better-Paid Medical Homes. (J. Lester Feder) This article published in Health Affairs reports on a health plan's efforts to improve the practices of primary care practices by implementing the medical home model and applying a risk-adjusted capitated payment model. The pilot was successful in reducing costs while also raising quality indicators. Health Affairs, 30(3): 397-399. doi:1Q.1377/hlthaff.2011.0112.
Key Design Elements of Shared- Savings Payment Arrangements: Commonwealth Fund. Shared savings is a payment strategy that offers incentives for providers to reduce health care spending for a defined patient population by offering them a percentage of net savings realized as a result of their efforts. The concept has attracted great interest, in part fueled by Affordable Care Act provisions that create accountable care organizations and by the movement among medical home pilots to make payment methodologies more performance-based. In this issue brief, the authors interviewed payer and provider organizations and state agencies involved in shared-savings arrangements about their diverse approaches, including the populations and services covered, the assignment of providers, the use of risk adjustment, and the way savings are calculated and distributed. The authors identified issues payers and providers must resolve going forward, including determining whether savings were achieved, equipping providers with necessary tools and technical advice, agreeing upon standard performance measures, and refining the model over time. Citation: M. Bailit and C. Hughes, Key Design Elements of Shared-Savings Payment Arrangements, The Commonwealth Fund, August 2011. Issue Brief (538K PDF)
Toward Accountable Care: Eight Models of Risk-Sharing in Health Care Delivery. The new Medicare Shared Savings Program is designed to accelerate the creation of accountable care organizations, payer-provider alliances for deliverying high-quality health care at lower cost through new payment models that reward efficiency. A new Commonwealth Fund study prepared by Catalyst for Payment Reform, in partnership with Booz Allen Hamilton, reports on the implementatin of eight private accountable care organizations that use, or are planning to deploy, a shared payer-provider risk payment model. Still in an early developmental phase, these payment models vary not only in their design but in how they define shared risk. The authors find that very health care providers and private-sector payers have experience with shared-risk payment arrangements. It will be critical, they say, for private-sector purchasers and payers to continue to experiement with both shared-savings and shared-risk arrangements in the search for successful ways to align incentives for high-value care.
Read more to learn about what it will take for accountable care organizations to succeed, and what the most effective payment models to support them are.