Managed Care - September 2008 - (Page 39)

tients receive care according to nationally endorsed evidence-based guidelines. If Dartmouth improves both the quality and efficiency of care, the medical center will receive a financial reward; no penalty will be assessed for failure. Group Health and Health Insurance Plan of New York — two leading insurers in New York — in January announced a two-year medical home pilot. About 20,000 patients will be randomly assigned to a physician practice that serves as a medical home. An evaluation will compare the results of the medical home participants with those of patients assigned to a control group. UnitedHealth Group is conducting a medical home pilot program in Florida in conjunction with the American Academy of Family Physicians, the American Academy of Pediatrics, the American Osteopathic Association, and the American College of Physicians. overall,” says Zimmermann of HealthPartners. “This is where the private sector is already heading in terms of working with providers on different ways to pay for services.” HealthPartners likes its chances in the new world envisioned by MedPAC. “We think integrated systems like HealthPartners are poised to be rewarded in this type of payment system,” Zimmermann says. Bundled payments While the medical-home initiatives are important, health plan executives should also note just how tough MedPAC is on hospitals. For instance, three recommendations focus on moving toward a so-called bundled payment that forces hospitals, physicians, and other caregivers to cooperate with one another to control the volume and cost of services delivered for an episode of care. The three recommendations are: Report information — confidentially at first, and then publicly — about how individual hospitals and physicians care for patients during and after a hospitalization. Reduce payments to hospitals that have high readmission rates for certain conditions, and allow hospitals to reward physicians financially for helping to reduce readmission rates. Conduct a pilot test of a bundled payment strategy in which a hospital and its affiliated physicians would receive a single payment for all services associated with a hospitalization and for all related services in the 30 days after the patient is discharged. If adopted, MedPAC’s recommendations could reinforce payment reform initiatives surfacing from private payers around the country. “As a health plan this exactly corresponds to what we think needs to happen in payment reform Bold action needed The Mayo Clinic, which has emerged as a leader in the health care reform movement, has convened more than 800 stakeholders in events sponsored by its Health Policy Center in the past two years. The consensus from those conversations is that bold action is needed to fix Medicare, which is an essential component of any coherent, sustainable health care system. “MedPAC’s recommendations are small steps but steps in the right direction,” says Bruce Kelly, Mayo’s director of government relations. “If we had our druthers, we would probably go further with Medicare to try to get away from its current model.” The advantage of MedPAC’s recommendations, Kelly says, is that they are politically viable. But the MedPAC recommendations will not be enacted without some fights. “There’s a lot of money riding on these changes,” says Stuart Guterman, senior program director for the Commonwealth Fund’s Program on Medicare’s Future. He takes encouragement that over the past few years, “We’ve really made tremendous progress in accepting the fact that you need to start paying for what you want because you get what you pay for.” That does not change the truth that what is good for society in the long run may be bad for parts of the health care industry right now. “There’s got to be a point where the interested parties — physicians and hospitals and other providers, insurance companies, and the people who receive health care — are going to understand that it’s time to stop fighting for a first-class berth on a ship that’s headed toward an iceberg,” he says. “The system is falling apart, and no one is going to be better off if we don’t do some pretty substantial things to change the way we view health care in this country.” MC SEPTEMBER 2008 / MANAGED CARE 39

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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