Multi-Sector Payment Reform
Each state must decide whether it will invest in multi-sector payment reform. Reforms implemented in both public and private sectors will produce more change then the same reforms implemented in one sector. They also require more time and resources to plan.
*Milestone details:
*Full name: Decide whether to pursue multi-sector payment reforms to promote quality and efficiency.
*Relevance to the ACA:
Aligning payment model, improvement strategies, and evaluation methods across sectors promises efficient use of resources and broadens the potential effect of reforms. However, while the public and private sectors share many goals, their specific priorities, populations served, and overall targets for improvement often vary. As a result, reaching the agreements needed to act in concert across sectors requires time, resources, and sustained commitment. The ACA provides several opportunities for states to experiment with payment models, including a provision that enables states to test all-payer reforms (§3021). In addition, the public sector payment reforms that might benefit most from partnerships, include:
§2703 - Allows Medicaid to make payments to health homes for Medicaid enrollees with chronic conditions.
§2705 - Authorizes states to use global capitated payment models in Medicaid to make payments to safety-net hospital systems or networks.
§2706 - Provides Medicaid incentive payments for meeting certain performance and savings requirements for pediatric medical providers organized into accountable care organizations.
§3022 - Provides Medicare shared savings for providers organized into ACOs.
§3023 - Payment bundling in Medicare for episodes of care around a hospitalization.
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District of Columbia
In the May issue of Health Affairs, Paul Ginsburg discusses possibilities in the next five to ten years to change provider payments and gradually diminish the role of fee-for-service reimbursement in order to contain health care costs.
District of Columbia
Did you participate in NASHP’s “Strategies for Payment Reform in States: Selecting Innovative Models” webinar on March 19? Feel free to continue the discussion here! Pose a question to your peers or post your state’s approach to payment reform. Some important questions that we weren't able to get to during the webinar were:
--When payers say, "We want to pay for value not just performance", what are they meaning by "value"?
--What type of health care market would favor one payment reform approach over another?
--What tools/metrics exist for evaluating the patient experience with the various payment reform models?
District of Columbia
Did you attend the "Laying the Groundwork in States for Payment Reform and More Integrated Delivery" webinar or conference call? We’re excited to kick off the inaugural discussion thread for this webinar series. We wanted to continue the conversation and offer you the chance to consult with your peers about the issues raised in the webinar.
We encourage folks to post their own questions and thoughts about how states can foster more integrated delivery systems here. Unfortunately, we didn't get the chance to address every question during the webinar so to get started here are some questions posed during the webinar:
• What approaches are available in state environments that are less conducive to implementing the Affordable Care Act or taking an active role in financing/delivery reform?
• How can states work to align state leadership?
• Where does behavioral health treatment fit into payment and delivery reform?
• How can states get purchasers off the sidelines and participating in reform?
• What approaches to the funding and organization of workforce development show promise as coverage/demand expands?
Review the slides at
http://www.nashp.org/webinar/laying-groundwork-states-payment-reform-and...
if you want to refer to a specific point from the webinar and don't forget to visit the Integrated Delivery Systems Toolkit!
California
Catalyst for Payment Reform, a nationwide coalition of large employers and health care purchasers has just released a report outlining the effect of provider consolidation and market power on health care prices, and sharing strategies purchasers and policymakers can use to address the issue.
District of Columbia
In the October issue of Health Affairs, Robert Mechanic, Stuart Altman and John McDonough describe efforts at health cost containment in Massachusetts since the expansion of health coverage in 2007. The state legislature recently enacted a cost control bill that sets annual state spending targets, encourages the formation of accountable care organizations, establishes an independent commission to oversee health care system performance, and creates a framework for increased regulation if spending trends continue upward. They also highlight lessons from Massachusetts' experience in enacting these reforms.
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
Many state governments and insurers are collaborating to reduce spending growth to a more sustainable level by improving provider payment models. Several current approaches to payment reform that offer insight for future federal and state policies will be explored in an upcoming NIHCM webinar, including:
- the Health Care Payment Improvement Initiative underway in Arkansas,
- the Alternative Quality Contract developed by Blue Cross Blue Shield of Massachusetts,
- the recent Massachusetts cost containment legislation, and
- the use of value-based purchasing for controlling costs.
Register at: http://nihcm.org/component/content/article/324-transforming-the-health-c...
District of Columbia
Yesterday, CMS selected markets for the new Comprehensive Primary Care (CPC) Initiative. Under the CPC, the CMS Innovation Center is inviting other payers--including states, Medicaid managed care organizations, and commercial carriers--to join Medicare in supporting medical homes. Learn more and share your thoughts here: http://www.statereforum.org/node/75
Oregon
Please find Dr. Judy Mohr Peterson's presentation attached
New York
This report from the United Hospital Fund describes the development and early successes of the Adirondack Medical Home Demonstration, and draws lessons that may be useful to other regions of the state and the entire nation: http://www.uhfnyc.org/publications/880729 .
This earlier and related report from the United Hospital Fund assesses the opportunities and challenges for multipayer collaborations to be critical agents of reform in health care delivery.
http://www.uhfnyc.org/publications/880709 .
Massachusetts
In February 2011 the Governor filed comprehensive legislation to improve health care quality and control health care costs. The bill will lower health care costs for consumers while providing the health care industry both the incentives and the freedom to innovate and find lower cost ways to deliver better care. The bill is currently in the Massachusetts legislature. Fore more information:
http://www.mass.gov/?pageID=gov3terminal&L=3&L0=Home&L1=Legislation+%26+...
Prior to filing comprehensive payment reform legislation, the administration worked with many stakeholders to develop recommendations about key decision points to inform the legislation. This page contains information regarding the Massachusetts Committee on the Status of Payment Reform Legislation. This committee of the Health Care Quality and Cost Council was charged with reviewing a draft outline of legislation to implement payment reform in Massachusetts and solicited input from interested stakeholders and experts.
http://www.mass.gov/?pageID=hqccmodulechunk&L=1&L0=Home&sid=Ihqcc&b=term...
Maine
The Rhode Island Chronic Care Sustainability Initiative, a multi-payer medical homes program, launched in October 2008. To learn more about CSI-RI, visit: http://www.ohic.ri.gov/Consumers_Premiums_CSI.php. CSI-RI is also discussed in pages 54-55 (60-81 of the PDF) of this report: http://www.statereforum.org/sites/default/files/healthy_ri_task_force_re...
Maine
This presentation reviews ACA provisions related to payment reform, discusses payment reform efforts already underway in Maine, and analyzes risks and opportunities for payment reform going forward.
Access the presentation here:
http://www.statereforum.org/sites/default/files/me_paymt_reform_pres.pdf
District of Columbia
This report details what health reform means for Colorado, including both requirements and opportunities in the ACA. It also contains information and updates from Colorado’s interagency health reform implementation board.
Access the report here:
http://www.statereforum.org/sites/default/files/co_roadmap.pdf
District of Columbia
This bill would set forth a strategic plan for establishing a single-payer and unified health care system for Vermont, establish a health benefit exchange, and establish a board that would oversee cost-containment and payment reform efforts. Access the bill here:
http://www.statereforum.org/sites/default/files/h-202.pdf
District of Columbia
This testimony provides Governor Shumlin’s recommendations for implementing health reform, including establishing an exchange and health reform board that would help the state transition to a single-payer system after 2017. Access the testimony here:
http://www.statereforum.org/sites/default/files/testimony_of_anya_rader_...
District of Columbia
This report presents a summary of public input received and workgroup recommendations on issues relating to delivery system reform, including payment reform, insurance product regulation, behavioral health, controlling costs, and many others.
Access the report here:
http://www.statereforum.org/sites/default/files/md_finalreportdeliverysy...
Maryland
Here are the Payer/ Provider Participation Agreement, Payment Methodology and an Community Care Coordination Options paper from the Maryland Multi-Payer Patient Centered Medical Home Program. Grace Zaczek, Maryland Medicaid Program
District of Columbia
The Iowa Legislative Health Care Coverage Commission presented 18 recommendations to General Assembly regarding implementation of the ACA. Highlights include planning for a new eligibility system to support Medicaid, CHIP, implementing a number of cost-containment strategies, and establishing an operational insurance information exchange by July 1, 2011.
Access the presentation here:
http://www.statereforum.org/sites/default/files/final_2010_comm_recommen...
District of Columbia
This report, issued by the Iowa Legislative Health Care Coverage Commission, provides an overview of the commission’s activities from July to September of 2010. Highlights include an overview of health reform presentations and state agency updates given to the commission by stakeholders and state officials, as well as a summary of the meetings convened by Iowa’s health reform workgroups through September 2010.
Access the report here:
http://www.statereforum.org/sites/default/files/ia_quarterly_report_jul-...