Quality and Efficiency
The American health care system is the most expensive in the world but does not deliver value for the investment. As purchasers, regulators and conveners, states can take steps to support and reward high quality and efficient systems of care.
The ACA provides states with new tools for improving the quality, efficiency, and value of the health care system. Provisions support public reporting, fraud reduction, and multi-sector payment reform. The ACA provides incentives to deliver low-cost, high-quality care, for example: reduce preventable hospital complications and readmissions; avoid overuse of ineffective tests and procedures; manage chronic conditions; and achieve administrative efficiencies.
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District of Columbia
Those interested in this topic may wish to see these recent announcements from CMS:
- Guidance on integrated care models: http://www.statereforum.org/discussions/care-coordination-financing#comm...
- State Innovation Models Initiative: http://www.statereforum.org/discussions/medicaid#comment-11127
District of Columbia
In this April 2012 Health Affairs article, Lee Newcomer of United Healthcare draws attention to the incentives inherent in traditional approaches to reimbursing medical oncologists. Newcomer outlines the problematic aspects of current “buy and bill” payment arrangements, and explains how these incentives encourage the use of high-cost drugs. Newcomer also discusses a new episode-based payment pilot that United is testing. The pilot aims to address many of the problematic aspects of traditional oncology reimbursement systems.
Read the full text below. And tell us: what do you think about the United pilot? Are public or private payers in your state experimenting with episode-based payment for services? Chime in with a comment.
Washington
Newcomer article on changing physician incentives for cancer care is a contribution towards the evolving landscape of payment reform towards an outcome based system from a production based system. The current “buy and bill” system puts the oncologist in an untenable position that affects their own income. This pilot offers a solution to one issue of misaligned incentives in our health care system. The challenge is taking it from a private payer pilot, to widespread adoption in the private and public systems. I’d like to see some efforts in Medicaid or public employees incorporating this payment reform, targeted steps like this are needed to truly reform our payment system, and ultimately, our health care system.
District of Columbia
Excellent point, Richard. From your previous position in Washington State, you might have added something like this to the Washington Health Authority's purchasing for Medicaid AND state employees. (Richard is now the new Executive Director of Washington's Exchange.) while all the emphasis on better primary care incentives is important, would love to hear from other states about what payment reform strategies they are considering for specialty care for Medicaid or state employees