Health Care Payment Reform

Speaking at the National Press Club last week, Mayo Clinic CEO Denis Cortese listed several attributes of organizations that deliver  what he considers to be “high-value care.” The Health Affairs blog recounts his message:

• patient-centric cultures
• high levels of physician engagement in leadership and change
• high levels of teamwork, collaboration, and coordinated care
• more “connectivity” and sharing of electronic medical records and information
• use of “the science of health care delivery” meaning systematically looking at how patients flow through an organization in order to reduce waste and standardize processes to reduce errors.

He also offered an incremental approach to move all health care providers in that direction:

Let’s set a goal that in three years Medicare is paying for value. In those three years, let’s create a process where we define what we mean by value. We start setting up the metrics — the outcomes, safety, and service compared to the cost – and let’s start being transparent about where everybody is on that scorecard.

Dr. John C. Lewin, chief executive of the American College of Cardiology, shares his view of health care payment reform in this Q&A in a blog post on The New York Times website.

A snippet of encouragement from Dr. Lewin:

The good news — and the reason why I’m excited about health care reform — is that the best health care in this country often tends to be very affordable. The whole discussion about bending the cost curve can be resolved by setting new incentives in payment that reward better outcomes with evidence-based medicine.

Everyone interested in health care payment reform should become acquainted with the Center for Payment Reform.

Its policy papers include Promoting Appropriate Payments for the Value Provided by Primary Care and Care Coordination:

Payment reforms must recognize the value provided by primary care in managing the health of individuals and populations. We will not create a delivery system that is patient-centered and well-equipped to deliver high quality care while controlling costs without changing payments to recognize the value of care coordination and the management of patients, particularly those with complex chronic illnesses.

The current New England Journal of Medicine features a roundtable discussion of some very smart people talking about health care cost control. I like Meredith Rosenthal’s starting point:

…I think looking at reforming the health care payment system would be number one on my list for ways to start approaching cost control.

Check out the video or read the transcript.

There’s going to be a lot of angst among physicians around the country over this, and quite understandably so.  But we need to be part of the solution, and this is a potential part of the solution.

That’s what Mario E. Motta, MD, president of the Massachusetts Medical Society, says about the proposal for accountable care organizations to replace fee-for-service medicine in his state.

Read my article in Neurology Today to find out more.

Many proposals for a new way to pay health care providers are being considered, and all of them have critics.

Into this fray, the American Academy of Neurology Professional Association has proposed its own payment strategy that would provide bonus payments, based on quality reporting and care coordination – that might actually lower the cost of treating some neurologic patients while improving the care they receive.

Read my article in Neurology Today to find out details.

If it’s done correctly, I think subspecialists can do well in this mode.

That’s what Edward R. Jones, MD,  president of Renal Physicians Association and a member of a six-physician practice in Philadelphia, thinks about the medical home concept.

Find out more about what the medical home may mean for subspecialists by reading my article in Nephrology Times.

Dawn Holcombe,  executive director of the Connecticut Oncology Association and president of DGH Consulting, says oncologists need to pay more attention to the changes that are coming:

I worry that a lot of them don’t understand what they’re about to be hit with.

While many payment reform ideas are being tested, three concepts emerge in almost all of them. Find out what they are by reading my article in Oncology Times.

Now that America’s fee-for-service payment system has become the favored target for criticism for health care payers and policymakers, the search is on for its successor. One popular candidate: episode-based payment that transforms the way oncologists and other providers are paid for their work.

Read my article in Oncology Times to learn more.

I’ll look anyone straight in the eye and say, ‘This is certainly good for the insurer, very good for the patient, and economically good for the doctor. Why can’t we set something up where everyone does well, as opposed to everyone doing badly?

–Roy Beveridge, MD, Medical Director for US Oncology, describing his company’s new program, Innovent Oncology.

US Oncology, the nation’s largest chain of cancer clinics, and Cancer Clinics of Excellence, a group of independent clinics, both see clinical pathways as a key component of payment reform for oncologists. To learn more, read my article in Oncology Times.