Setting the Stage for the Next 10 Years of Health Care Payment Innovation

Kocher, B; Rajkumar, Rahul

doi:10.1001/jama.2021.13153

Cited by 5 publications

(4 citation statements)

References 2 publications

(3 reference statements)

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“…Measuring primary care‐focused continuity of care may present several advantages for practice physicians. These claims‐based measures may require less clerical work relative to existing measures and serve to reward what PCPs already value: namely longitudinal, trusting relationships with their patients 50,51 . Existing volume‐based incentives in the primary care setting emphasize patient access to care, leading to fuller physician schedules and, therefore, might work against continuity by overscheduling clinician time and making it hard for a given patient to see his or her own doctor 15,52,53 .…”

Section: Discussionmentioning

confidence: 99%

Physician‐ versus practice‐level primary care continuity and association with outcomes in Medicare beneficiaries

Yang¹,

Davis²,

Dai

et al. 2022

Health Services Research

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Objective: To compare physician-level versus practice-level primary care continuity and their association with expenditure and acute care utilization among Medicare beneficiaries and evaluate whether continuity of outpatient primary care at either/ both physician or/and practice level could be useful quality measures.Data Source: Medicare Fee-For-Service claims data for community dwelling beneficiaries without end-stage renal disease who were attributed to a national random sample of primary care practices billing Medicare (2011Medicare ( -2017.Study Design: Retrospective secondary data analysis at per Medicare beneficiary per year level. We used multivariable linear regression with practice-level fixed effects to estimate continuity of care score at physician versus practice level and their associations with outcomes.Data Collection/Extraction Method: We calculated clinician-and practice-level Bice-Boxerman continuity of care index scores, ranging from 0 to 1, using primary care outpatient claims. Medicare expenditures, hospital admissions, emergency department (ED) visits, and readmissions were obtained from the Medicare Beneficiary Summary File: Cost and Utilization Segment. Ambulatory care sensitive conditions (ACSC) were defined using diagnosis codes on inpatient claims.Principal Findings: We studied 2,359,400 beneficiaries who sought care from 13,926 physicians. Every 0.1 increase in physician continuity score was associated with a $151 reduction in expenditure per beneficiary per year (p < 0.01), and every 0.1 increase in practice continuity score was associated with $282 decrease (p < 0.01) per beneficiary per year. Both physician-and practice-level continuity were associated with lower Medicare expenditures among small, medium, and large practices.Both physician-and practice-level continuity were associated with lower probabilities of hospitalization, ED visit, admissions for ACSC, and readmission.Conclusions: Primary care continuity of care could serve as a potent value-based care quality metric. Physician-level continuity is a unique value center that cannot be supplanted by practice-level continuity.

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Section: Discussionmentioning

confidence: 99%

Physician‐ versus practice‐level primary care continuity and association with outcomes in Medicare beneficiaries

Yang¹,

Davis²,

Dai

et al. 2022

Health Services Research

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“…health care organizations may be rewarded, in case of assumption of some degree of financial risk when managing the quality and costs of care of a patient population treated with some specific technologies. 39 In the field of electrophysiology a series of contracts ("Outcome guarantee models") have been put in practice with some hospitals, with manufacturers giving back to providers large discounts or rebates if certain clinical/economic outcomes are not met after use the specific technology. 40 One example is that Medtronic offered a risk sharing agreement on the use of the Tyrx antibacterial envelope, including Medtronic will reimburse hospitals for selected costs if use of the Tyrx antibacterial envelope fails to prevent infection in patients implanted with a cardiac electronic implantable device (implant/replacement or upgrade of a pacemaker or defibrillator or device for cardiac resynchronization therapy).…”

Section: Current Experiences Of Risk-sharing Agreements In the Field ...mentioning

confidence: 99%

Performance-based risk-sharing arrangements for devices and procedures in cardiac electrophysiology: an innovative perspective

et al. 2022

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There is an increasing pressure on demonstrating the value of medical interventions and medical technologies resulting in the proposal of new approaches for implementation in the daily practice of innovative treatments that might carry a substantial cost. While originally mainly adopted by pharmaceutical companies, in recent years medical technology companies have initiated novel value-based arrangements for using medical devices, in the form of ‘outcomes-based contracts’, ‘performance-based contracts’, or ‘risk-sharing agreements’. These are all characterized by linking coverage, reimbursement, or payment for the innovative treatment to the attainment of pre-specified clinical outcomes. Risk-sharing agreements have been promoted also in the field of electrophysiology and offer the possibility to demonstrate the value of specific innovative technologies proposed in this rapidly advancing field, while relieving hospitals from taking on the whole financial risk themselves. Physicians deeply involved in the field of devices and technologies for arrhythmia management and invasive electrophysiology need to be prepared for involvement as stakeholders. This may imply engagement in the evaluation of risk-sharing agreements and specifically, in the process of assessment of technology performances or patient outcomes. Scientific Associations may have an important role in promoting the basis for value-based assessments, in promoting educational initiatives to help assess the determinants of the learning curve for innovative treatments, and in promoting large-scale registries for a precise assessment of patient outcomes and of specific technologies’ performance.

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“…Unlike Medicare for All, MA for All could leverage the existence of multiple MCOs to compete on value. Despite efforts to promote fee-for-value payment models, a minority of direct medical spending flows through alternative payment models with 2-sided risk, in which payers and clinical delivery organizations partner to share the financial risks of overspending as well as savings from effective clinical management . Without more pervasive downside accountability for costs and standardized fee schedules across payers, clinicians and health care organizations will continue to have perverse incentives to increase volumes and cross-subsidize across service lines and payers.…”

Section: Benefits Of Ma For Allmentioning

confidence: 99%

“…Despite efforts to promote fee-for-value payment models, a minority of direct medical spending flows through alternative payment models with 2-sided risk, in which payers and clinical delivery organizations partner to share thefinancialrisksofoverspendingaswellassavingsfromeffectiveclinical management. 5 Without more pervasive downside accountability for costs and standardized fee schedules across payers, clinicians and health care organizations will continue to have perverse incentives to increase volumes and cross-subsidize across service lines and payers. Under MA for All, the risk-adjusted, capitated premiums set by CMS could represent the cost to provide care and incentivize MCOs to adopt value-based payment models.…”

Section: Benefits Of Ma For Allmentioning

confidence: 99%

Medicare Advantage for All

Zahner

Croughan

Blumenthal

2022

JAMA

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A growing majority of people in the US support universal health insurance, 1,2 but important questions remain about what is the best and most politically palatable framework for realizing this goal. Some policy makers have advocated for universal coverage through "Medicare for All," which would consolidate private and public health insurance into a single payer administered by the Centers for Medicare & Medicaid Services (CMS).However, Medicare for All has several key limitations and risks. Eliminating private health insurance would effectively eliminate a large sector of the US economy. Additionally, this model would leave an unclear role for managed care organizations (MCOs), which are how most individuals in the US currently receive health insurance coverage. 3 Moreover, in a survey of 1190 US adults, 58% reported they would oppose a national health plan if it eliminated private insurance. 1 Medicare Advantage (MA) for All-which would create a national guarantee for health insurance while maintaining private-sector involvement in health insurance administration-represents an alternative path to achieving universal health insurance that could mitigate many of the disadvantages of Medicare for All. 3 This Viewpoint outlines what MA for All might look like and describes potential benefits, limitations, and risks.

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Setting the Stage for the Next 10 Years of Health Care Payment Innovation

Abstract: This Viewpoint describes 4 health policy strategies that could help lead to improvements in cost and quality in the US health care system.

Cited by 5 publications

References 2 publications

Physician‐ versus practice‐level primary care continuity and association with outcomes in Medicare beneficiaries

Physician‐ versus practice‐level primary care continuity and association with outcomes in Medicare beneficiaries

Performance-based risk-sharing arrangements for devices and procedures in cardiac electrophysiology: an innovative perspective

Medicare Advantage for All

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