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There are countless efforts underway at the national, state, and local levels to change how we pay for and deliver healthcare. And, they go far beyond just lowering costs. Members of the Alliance of Community Health Plans, including my organization, HealthPartners, are exploring innovative new approaches to payment. These are detailed in a new report titled, “Rewarding High Quality: Practical Models for Value-Based Physician Payment.”

 

The Triple Aim

The most promising and successful alternative payment models are organized around the Triple Aim which has the goal of improving health and the patient experience while enhancing affordability. The Triple Aim goes hand-in-hand with the idea that payment reform must represent a win for the payer, a win for the care system, and, most importantly, a win for patients. This is particularly important because now, more than ever before, healthcare consumers have more exposure to the cost of their care and are more inclined to seek and demand value. This means a focus on value and away from volume in terms of what payment systems reward.

At HealthPartners, for example, our primary care case-rate payment methodology is designed to move payment away from the traditional fee-for-service model and to provide incentives for innovation in care designs that improve access, experience, and health outcomes. Another example is virtuwell—a 24/7 online clinic developed by HealthPartners that diagnoses and treats patients for dozens of common conditions for a simple, upfront price and without requiring a visit to a physical clinic location. It’s convenient, remarkably satisfying for the more than 200,000 patients who have used it to date, and saves an average of about $105 per episode versus in-person care—definitely a Triple Aim win.

 

Partnership is key

What enables these kinds of advancements? Central to a successful new payment approach is a true spirit of partnership between the payer and the care system, including hospitals and physicians, which means maintaining transparency in every aspect of the relationship. This includes transparency around the data that are shared to inform the relationship, as well as in the parameters of success that ultimately guide it. Other components of success include regular communication and reporting between the payer and the care system, as well as the ability to scale the model to the particular circumstances of the care system in play.

At HealthPartners, we meet with physician practices to review their Triple Aim results and identify new opportunities to improve. We meet as often as needed, with a minimum being two times per year. We customize our consultations to the needs of individual groups. These needs can range from basic registry feeds to complement their electronic health record data to evaluating panel-based predictive models to be proactive with patient care. For reference, we make available publically an annotated user guide and user tools with further details about how this appears in practice.

 

Practical tools are needed

A commitment to transparency is a good first step, but practical tools are also needed to make new payment models work for everyone. In 2012, for example, HealthPartners introduced a set of Total Cost of Care and Resource Use measures that were the first of their kind to be endorsed as a national standard by the National Quality Forum. Released freely into the public domain, and currently in use in dozens of states across the country, the measures allow analysis of healthcare costs and resource use for entire populations as well as specific conditions within a population.

Providers, insurers, government agencies, employers, consumers, and other organizations use the measures to manage costs, drive affordability, and improve delivery of healthcare. Our hope in releasing them freely is that they would complement existing quality measures to provide a much-needed, common reference point supporting the development of accountable care organizations and payment reform models.

Among the many examples of the meaningful use of this methodology, we can point to our own state of Minnesota. For instance, MN Community Measurement (MNCM) has reported on quality, cost, and patient experience since 2003, working with medical groups, health plans, employers, consumers, and state agencies. Recently, MNCM adopted the Total Cost of Care and Resource Use methodology to drive statewide reporting, complementing other quality, experience and payment transparency information that the organization makes available on their website, giving patients access to a plethora of helpful tools.

In order to truly realize the vision of the Triple Aim, health plans and other industry leaders must embrace examples of payment reform like these and others now emerging, while realizing that collaboration and transparency will be central to those efforts. It is vital that healthcare measurement and payment methods support innovation within the care systems—and every player in the healthcare system has a role to play.

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