Managed Healthcare Executive - December 2008 - (Page 20)

{ S P E CI AL RE PO R T} payments for Part A and Part B, CMS major recommendations. system], we’re going to need to give sigwill provide a single payment to hospitals Ideally, the payments would bundle ni cant attention to the incentives that and providers for 28 cardiac and nine all related medical services, from initial we o er providers,” Dr. Schoenbaum orthopedic inpatient surgical services. hospitalization to a de ned period post- says. “Anything that sounds remotely Because the predetermined payment hospitalization, including preventable like capitation is going to cause them will be split between the hospital and rehospitalizations. Payments also would to say, ‘We’ve been there. It was awful, physicians, Medicare hopes they will be risk-adjusted to avoid adverse patient and we aren’t doing that again.’” collaborate more closely to avoid com- selection. The report continues to say To get provider buy-in, payers will plications and unnecessary procedures, that P4P should be expanded and that the need to reassure providers that their thus preserving more of the payment more bundled the payment mechanism, needs have been addressed. If insurers for themselves. the greater the proportion of the payment agree to pay providers fairly, and proShould the program be successful, it should be tied to performance. viders are given the freedom to orgadoesn’t mean that there nize themselves in a model will be a one-size- tsthat allows them to provide all approach to bundling high-quality care, then “we payments in the future, can at least sit down at the experts say. As long as table and start to gure out the payment model is the details,” he says. Payment reform with arrangements to bundle all fair, understandable and related medical services takes provider concerns CREATING THE FIRE about risk into account, The healthcare payment Risk-adjusted payment to avoid adverse patient selection the system should natmodel of the future urally organize itself might be named after Expansion of pay for performance around the model to a mythical story from make it more e ective the past. According to Payments tied to performance proportionate and e cient. Greek mythology, the with the degree of bundling of services Best of all, it doesn’t gods kept the secret require a complete tearof re from mortals, Source: The Commonwealth Fund down of the current but Prometheus—one system, according to of gods’ archrival TiStephen Schoenbaum, MD, MPH, the The study revealed four signi cant tans—taught humanity Commonwealth Fund Commission’s ndings: how to create re. executive vice president of programs and The ideal delivery system is achievTrue to its name, Prometheus Payexecutive director of the Commission on able; many existing delivery systems already ment Inc., a not-for-pro t corporation a High Performance Health System. have many of the necessary attributes; launched with a $6 million grant from the “The structural elements that we There is more than one way to or- Robert Wood Johnson Foundation, was need currently exist in our healthcare ganize providers to achieve those key created to shed light on these dark days of system, but we need them to be bet- attributes; healthcare payment reform. The model’s ter organized,” he says. “We don’t want Although there are diverse ap- moniker, PROMETHEUS, stands for fragments of care, because that leads to proaches, some form of organization— Provider payment Reform for Outcomes, fragmented payment. By bundling care mechanisms that can work across provid- Margins, Evidence Transparency, Hassle and payments, we take one step closer ers and settings—is necessary to achieve reduction, Excellence, Understandability, to caring for the whole person.” those attributes; and and Sustainability. Leadership is a critical factor in the By creating common clinical incenRISK ADJUSTMENT success of delivery systems. tives for all parties, the organization In August, the Commonwealth Fund However, Dr. Schoenbaum acknowl- strives to improve quality, lower adCommission published “Organizing edges that if we build it, they still might ministrative costs and facilitate better the U.S. Health Care Delivery Sys- not come. After providers’ experience clinical coordination. Its payment model tem for High Performance.” While with capitation in the 1990s, the majority is expected to create an environment the report focused on fragmentation might still be gun-shy about assuming where doing the right things for the of care, particularly at the community nancial risk for providing care. patient helps providers and insurers do level, payment reform was one of its “To encourage [a bundled payment well for themselves. Pilot projects target Commonwealth Fund recommendations 1 2 3 4 20 DECEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - December 2008

Managed Healthcare Executive - December 2008 For Your Benefit Editorial Advisors Contents News Analysis Politics & Policy Letter of the Law Puerto Rico’s PLAN State Report Bundled Payment Technology Drug Class Overview Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - December 2008

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