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Update: Moving from Payments Promoting Volume to those Promoting Value and Population Health

This project aims to review the necessary capacities and strategic priorities to transition healthcare financing from volume-based to value-based models. By engaging multiple stakeholders and developing a discussion paper, the project seeks to identify barriers and propose solutions for advancing payment reform. The subsequent stages involve further analysis, case studies, and dissemination strategies to drive progress towards an effective, efficient, and health-enhancing healthcare system.

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Update: Moving from Payments Promoting Volume to those Promoting Value and Population Health

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  1. Update: Moving from Payments Promoting Volume to those Promoting Value and Population Health September 30, 2019

  2. Background • Need for health care financing to shift from rewarding service volume to quality and health outcomes • HHS has met its 2016 goal for 30% of Medicare payments to alternative payment models focused on value and quality. 2018 targets of 50% awaiting results • In FY 2020, HHS anticipates expanding payment models that incorporate downside risk

  3. Background (cont.) • Other approaches being explored include CMS’ Primary Care First Model and Direct Contracting and the HCP-LAN Framework and Roadmap • Yet, the path and transition to wide-scale implementation of models that lead us to value and population health are not clear

  4. Goals of This Project • Review core capacities necessary to transition to health financing focused on value and population health • Explore the strategic priorities and actions necessary to advance those capacities • Engage leaders of organizations representing multiple stakeholders • Advance progress toward a health system that is effective, efficient, and health enhancing

  5. Proposed Next Steps: Stage 1 • Convene multi-stakeholder leadership including public and private payers; professional societies; hospitals and health systems; industry; employers; quality improvement and measurement groups; researchers; and patient, family and community-based organizations • Authors to develop an NAM Discussion Paper to: • Provide overview of current health financing landscape, including incentives and rewards, and state of alternative payment models progress • Consider and highlight changes most needed to advance payment reform • Identify options for addressing the most compelling barriers, including key stakeholder responsibilities, and supportive policy initiatives • Timeline: 6-9 months

  6. Proposed Next Steps: Stage 1 (cont.) • Topics in NAM Discussion Paper draft outline • Define vision for success for moving from fee-for-service to value and population health • Review current legislative efforts, CMS’ strategies, and ongoing work of key organizations on the development and implementation of alternative payment models • Specifyconditions required for progress, challenges involved, and potential approaches and strategies forpayers, health systems, providers, communities, and patients—e.g. • Accountability measures oriented to system-level performance on core needs and results • Transparency in risks, payments, and the performance to payment timeline • Approaches and rewards for downside financial risk, population-based payments, and links between medical and social services • Non-financial incentives and when/where most effective • Risk adjustment tools and incentives to accommodate needs of population subgroups that require additional, tailored, and/or community-supported care • People, communities, delivery organizations, and payers in active partnership • Map options for stakeholder levers, roles, responsibilities, actions required

  7. Proposed Next Steps: Stage 2 • Continue convening of leaders from multi-stakeholder organizations to develop a more detailed NAM Special Publication, an Action Plan, and a dissemination strategy that will: • Delve more deeply into issues and actions in the NAM Discussion Paper • Develop, with broader input, wide ranging strategies and critical steps to advance health financing • Identify case studies of best and promising practices from payers, health systems and hospitals, employers, and patient and community groups • Develop webinars and stakeholder group relevant materials • Timeline: 12-24 months

  8. Questions for Discussion • Which core capacities are most important to explore in the work? • What current activities or initiatives will most help inform the work? • What other considerations or consultations should be folded into this effort?

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