Early Results Show WellPoint’s Patient-Centered Medical Home Pilots Have Met Some Goals For Costs, Utilization, And Quality

Raskas, Ruth S.; Latts, Lisa; Hummel, Jill R.; Wenners, Douglas; Levine, Harlan B.; Nussbaum, Sam

doi:10.1377/hlthaff.2012.0364

Cited by 32 publications

(26 citation statements)

References 3 publications

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“…20 WellPoint uses "value-based payments" to supplement FFS reimbursements for primary care providers in PCMHs. 21 In this way, payments reward quality and efficiency and are intended to compensate physicians for non-visit-based services, such as maintaining disease registries. Several multipayer PCMH pilots provide a "management fee" (based on panel size) to participating providers.…”

Section: Value-based Supplemental Paymentsmentioning

confidence: 99%

Emerging Lessons From Regional and State Innovation in Value‐Based Payment Reform: Balancing Collaboration and Disruptive Innovation

et al. 2014

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Policy Points:r Public and private purchasers must create a "burning bridge" of countervailing pressure that signals "no turning back" to fee-for-service in order to sustain the momentum for value-based payment.r Multi-stakeholder coalitions must establish a defined set of quality, outcomes, and cost performance measures and the interoperable information systems to support data collection and reporting of value-based payment schemes.r Anti-trust vigilance is necessary to find the "sweet spot" of competition and cooperation among health plans and health care providers.r Provider and health plan transparency of price and quality, supported by all-payer claims data, are critical in driving value-based payment innovation and cost constraint. Context:In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. Methods:As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated The Milbank Quarterly, Vol. 92, No. 3, 2014 (pp. 568-623) Emerging Lessons From Innovation in Value-Based Payment Reform 569factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. Findings:The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations.Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. Conclusions:From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder enga...

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Section: Value-based Supplemental Paymentsmentioning

confidence: 99%

Emerging Lessons From Regional and State Innovation in Value‐Based Payment Reform: Balancing Collaboration and Disruptive Innovation

et al. 2014

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“…3 Research evaluating the PCMH's effectiveness in achieving the goals of improved care quality, patient experience, and reduced healthcare costs has encouraged further refinement of the model. [4][5][6][7][8][9][10][11] Facilitators and barriers to the creation of a successful PCMH have been explored in a limited number of heterogeneous settings, including small practices, large group practices, high-performing practices, and safety net clinics. [12][13][14][15][16][17] To date, significant challenges have been identified; specifically, the investment of resources for infrastructure changes and the leadership skills needed to guide an organization through paradigm-shifting cultural change.…”

Section: Introductionmentioning

confidence: 99%

Minnesota’s Early Experience with Medical Home Implementation: Viewpoints from the Front Lines

et al. 2014

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BACKGROUND:Evidence is evolving about the impact of patient-centered medical homes (PCMHs) on important outcomes in primary care. Minnesota has developed its own PCMH certification process, envisioned as an all-payer initiative with an emphasis on patientcenteredness, which may add unique experiences and outcomes to the national discussion. OBJECTIVE: We aimed to identify the facilitators and barriers encountered by nine diverse primary care practices selected from the first 80 to achieve PCMH certification in Minnesota. DESIGN: This was a qualitative analysis of semistructured, in-person interviews. PARTICIPANTS: Thirty-one administrative and clinical leaders, including clinic managers, physician champions, medical directors, nursing supervisors, and care coordinators participated in the study. KEY RESULTS: Six factors emerged as most important to the efforts to become PMCHs: leadership support, organizational culture, finances, quality improvement (QI) experience, information technology (IT) resources, and patient involvement. Facilitators included committed leadership at local and higher levels, prior experience and ongoing support for QI initiatives, and adequate financial and IT resources. Reimbursement was a significant barrier due to perceived inadequacy and inconsistent participation by health plans. The unsuitability of electronic medical records (EMRs) to PCMH documentation requirements likewise presented ongoing challenges. Many interviewees described patient input as helpful to their clinics' PCMHrelated changes and were enthusiastic about their "patient partners." The majority of interviewees felt that becoming a PCMH was right for patients and was personally worthwhile, even while acknowledging the tremendous effort involved and voicing skepticism about reimbursement over the short term. CONCLUSIONS: The experience of participants in Minnesota's state-wide initiative to legislate PCMH transformation provides a broad view of facilitators and barriers. Unique facilitators included a requirement for patient involvement, which pushed practices to create patient-centered innovations, and new reimbursement models based on quality indicators for a population.Among barriers were the costs to practices and patients, and EMRs that failed to accommodate PCMH requirements.

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“…7 One insurer recently reported a significant positive return on investment. 8 A review in 2010 concluded that "investing in primary care patient centered medical homes results in improved quality of care and patient experiences, and reductions in expensive hospital and emergency department utilization." 9 In one study, levels of clinicians' emotional exhaustion in a PCMH practice was significantly reduced compared to levels at two control clinics (14 % vs. 35 %, p<0.001).…”

Section: Ethics and Implementationmentioning

confidence: 99%

Ethical Challenges Come Home

Wynia

Sabin

2012

J GEN INTERN MED

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Early Results Show WellPoint’s Patient-Centered Medical Home Pilots Have Met Some Goals For Costs, Utilization, And Quality

Cited by 32 publications

References 3 publications

Emerging Lessons From Regional and State Innovation in Value‐Based Payment Reform: Balancing Collaboration and Disruptive Innovation

Emerging Lessons From Regional and State Innovation in Value‐Based Payment Reform: Balancing Collaboration and Disruptive Innovation

Minnesota’s Early Experience with Medical Home Implementation: Viewpoints from the Front Lines

Ethical Challenges Come Home

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