Because new payment models require effective and seamless care coordination among providers, new methods of delivering care have also been experiments in the living laboratory. Two in particular have become especially prominent.
The Patient-Centered Primary Care Collaborative (PCPCC) applauds the U.S. Department of Health and Human Services’ (HHS) goal for 30 percent of Medicare payments to be in alternative payment models by the end of 2016 and 50 percent by the end of 2018.
HHS’s commitment to alternative payment models, like Accountable Care Organizations (ACOs) and bundled payments, as well as innovative care delivery models, like the Patient-Centered Medical Home (PCMH), signifies a positive shift in payment reform policy that moves away from the traditional fee-for-service (FFS) system.
For the past ten months on Health Affairs Blog, we’ve been discussing the evidence for different models of payment reform, examining everything from pay for performance to nonpayment. But no discussion of payment reform is complete without addressing benefit and network designs and how they can help or hinder various payment reforms. When the right payment method is paired with the right benefit and/or network design, they can work together to help reduce costs and improve care.
If former Health and Human Services Secretary Kathleen Sebelius was the poster child for the pitfalls of health care reform, then Patrick Conway might be the hidden face of the law's promises.
A pediatrician and top administrator at Cincinnati Children's Hospital Medical Center until 2011, Conway is now leading the federal government's efforts to change the health care system – from one that rewards quantity to one that rewards quality.
Commercial health plans have “dramatically shifted” in how they pay hospitals and physicians, with 40 percent of all payments reflecting value over volume, but 60 percent of payments remain tied to the traditional fee-for-service model, according to the nonprofit Catalyst for Payment Reform.
