Milestone: Decide whether to pursue multi-sector payment reforms to promote quality and efficiency
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.
*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.less