High-Intensity Primary Care Payment: Good Return on Investment for Employers
As the largest purchaser of health care in America, employers are paying a high price for care of variable quality. To check soaring costs, some employers are switching from the inefficient fee-for-service model of paying for care, which encourages high volume and low quality, to payment models that reward high value.
This map provides an overview of the most up-to-date state decisions regarding the structure of their health insurance marketplaces. A health insurance marketplace (also known as 'health insurance exchanges') is a venue where individuals and small employers can shop for insurance coverage. According to the federal government, marketplaces must be set up by Oct. 1, 2013 for policies to take effect in Jan. 2014. The exchanges will also direct people to Medicaid, the government health insurance program for the poor, if they're eligible.
The National Academy for State Health Policy is tracking state efforts to lead or participate in accountable care models that include Medicaid and Children’s Health Insurance Program populations. Accountable care models aim to address lack of care coordination and wide disparities in cost and quality of care in the U.S. health care system, perpetuated by the prevailing fee-for-service payment method, through shared incentives to manage utilization, improve quality, and curb cost growth.
Value-Based Insurance Design (V-BID) - hailed as a "game changer" by the National Coalition on Health Care - refers to insurance designs that cary consumer cost-sharing to distinguish between high-value and low-value health care services and providers. V-BID entails (1) reducing financial barriers that deter use of evidence-based services and high-performing providers, and (2) imposing disincentives to discourage use of low-value care.
"Stabilizing health spending and targeting it in ways that ensure access to care and improve health outcomes would free up billions of dollars annually for critically needed economic and social investments."
To assess the impact of the MDVIP model of personalized preventive care on hospital utilization rates over a 5-year period.
Study Design:
This study was a comparative hospital utilization analysis between MDVIP members and nonmembers using the Intellimed database from 5 mandatory reporting states (New York, Florida, Virginia, Arizona, and Nevada) from 2006 to 2010.
The medical home is an approach to delivering and organizing primary care that helps achieve the goals of the Triple Aim: improve the experience of care, improve the health of populations, and reduce per capita costs of health care. A medical home achieves these goals by adopting new technologies, care delivery methods and relationships with patients and their families that encourage primary care to be patient-centered, comprehensive, coordinated, accessible and committed to quality and safety.
