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.
Patient-centered medical homes have long been thought to reduce healthcare costs. A recent study published in the journal Health Services Research confirms that they actually do.
The study looked at PCMHs recognized by the National Committee for Quality Assurance, as well as practices that are not—referred to as the “comparison group.” It found that medical homes with the NCQA seal had lower payments from Medicare (saving money for the program), less money spent on urgent or acute care, and fewer overall visits to the emergency department among the patients they saw.
Highmark Inc.'s Patient-Centered Medical Home (PCMH) program, which launched in October 2012, is showing positive results with statistical improvements in patient care, according to company data.
Highmark Inc.'s effort to improve the way medical care is provided is showing results.
Highmark's patient-centered medical home uses a team approach in caring for patients instead of the traditional patient-doctor relationship. Among the benefits of the new model for providers in the program for at least a year was a medical spending growth rate that was 13 percent lower than the market trend, according to a survey by the insurer.
Facing the fact that just 5 percent of the patient population was responsible for nearly half of its spending, one health organization has tried some fairly radical changes.
In Utah, Intermountain Healthcare decided to address the problem with primary care in an attempt to keep these most vulnerable patients from falling through the cracks.
Medicaid has offered an attractive venue for states and the federal government to pursue patient-centered medical home (PCMH) innovation experiments, but one state initiative that launched before PCMH certification even began offered potential lessons before it was curtailed for budget reasons, according to a recent study.
Patient-centered medical home practices spend about a third more per patient than non–medical home practices but earn nearly twice as much per patient after operating costs, the Medical Group Management Association reported.
Jeffrey Brenner doesn’t believe in blaming a person for showing up at an emergency room for a cold or an ear infection, even if the illness could have been treated in a doctor’s office at much lower cost. Instead, he faults the health care system, and he wants to prove that if providers, employers and insurers work together more effectively, that person will stop going to the ER.
Brenner, a 2013 MacArthur Fellow and executive director of the Camden Coalition of Healthcare Providers, is testing this theory with a randomized controlled trial. Findings are due out in 2016.
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.
Today, Catalyst for Payment Reform (CPR) unveiled some potentially exciting news: Our 2014 National Scorecard on Payment Reform tells us 40 percent of commercial sector payments to doctors and hospitals now flow through value-oriented payment methods, defined as payment methods designed to improve quality and reduce waste. This is a dramatic increase since 2013 when the figure was just 11 percent.
