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Developing a Playbook for Payment Reform

Developing a Playbook for Payment Reform. Robert S. Galvin, MD 4 th National Pay for Performance Summit March 10, 2009. Clinician to Purchaser. “If I keep improving quality and efficiency, I’ll go out of business.”.

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Developing a Playbook for Payment Reform

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  1. Developing a Playbook for Payment Reform Robert S. Galvin, MD 4th National Pay for Performance Summit March 10, 2009

  2. Clinician to Purchaser “If I keep improving quality and efficiency, I’ll go out of business.”

  3. Concern That Chaos, Complexity and Unintended Consequences Will Undermine Positive Impact Today • Agreement payment must change significantly from volume to value • Impressive number of private sector initiatives . . . but not coordinated • CMS moving in right direction but little input from private sector

  4. No Leadership and Growing Chaos Buyers Health Care Action Group Coalition Prometheus • Commercial Payer Programs • BCBS MN Recognizing Excellence Program • HealthPartners: Partners in Progress • HealthPartners : Partners in Excellence • Medica: Choice Care Quality Improvement Program • Medica: Performance-Based Incentive • Ucare P4P Program • Medicare Demos • Hospital Value based purchasing plan • Premier Program • Physician Group Project • Physician Quality Reporting Initiative (PQRI) 18 Medicaid: Managed Care P4P program Carol.com Aligning Forces For Quality (RWJF) Bridges to Excellence Minneapolis Minnesota Healthcare Value Exchange MN State Employee Group

  5. Payment Reform Leaders Need a Voice Who Will Influence Payment Reform? • Broad Agreement on Direction . . . Primary Care, Bundling, Pre-payment, Risk Adjustment • But Details Are Critical • Medicare Will Make a Big Difference • And Powerful, Vested Interests Are Engaged

  6. Hospitals Consolidation Higher Prices Improved Outcomes ± Payment Will Determine The Difference An Example: Bundled Payment Doctors . Integration Improved Outcomes Lower Costs

  7. A Unified Voice For Consumers, Labor, Purchasers, Willing Providers, Policymakers

  8. Create principles & roadmaps for reform Establish a national scorecard on payment Inform and coordinate local initiatives Facilitate private / public sector alignment Center for Payment Reform (CPR) Platform For Change

  9. A No “One Size Fits All” Approach Episode/Condition-Based Payment Population-Based Payment Fee-For-Service Pay-for-Performance Each strategy can include additional rewards and/or penalties against desired quality goals, including process, structure, and outcome metrics Reforms Will Vary Based on Market Conditions • Provider organization • Delivery system infrastructure • Active payment initiatives

  10. A Playbook for Payment Reform Path 1: Reforming Payment Path 2: Reforming Processes • Outline Payment Reform Strategies / Options • Measure Relative “Value” Of Each Option • Establish Detailed Recommendations • Map-Out Current Processes – Public and Private Sectors • Outline Policy Options and Specific Process Recommendations

  11. ’09 Strategy: The Playbook • Circulate Principles • Create & Finalize Roadmaps • Sign-on • Influence

  12. For More Information Contact: Anna Fallieras(203) 373-2352anna.fallieras@ge.com www.centerforpaymentreform.org

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