Developing a playbook for payment reform
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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 l.jpg

Developing a Playbook for Payment Reform

Robert S. Galvin, MD

4th National Pay for Performance Summit

March 10, 2009

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Clinician to Purchaser

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

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Concern That Chaos, Complexity and Unintended Consequences Will Undermine Positive Impact


  • 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

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No Leadership and Growing Chaos Will Undermine Positive Impact

Buyers Health Care Action Group Coalition


  • 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)


Medicaid: Managed Care P4P program

Aligning Forces For Quality (RWJF)

Bridges to Excellence


Minnesota Healthcare Value Exchange

MN State Employee Group

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Payment Reform Leaders Need a Voice Will Undermine Positive Impact

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

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Hospitals Will Undermine Positive Impact


Higher Prices

Improved Outcomes


Payment Will Determine The Difference

An Example: Bundled Payment




Improved Outcomes

Lower Costs

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Create principles & roadmaps for reform Providers, Policymakers

Establish a national scorecard on payment

Inform and coordinate local initiatives

Facilitate private / public

sector alignment



Payment Reform (CPR)

Platform For Change

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A No “One Size Fits All” Providers, PolicymakersApproach

Episode/Condition-Based Payment

Population-Based Payment



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

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A Playbook for Payment Reform Providers, Policymakers

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

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’09 Strategy: The Playbook Providers, Policymakers

  • Circulate Principles

  • Create & Finalize Roadmaps

  • Sign-on

  • Influence

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For More Information Contact Providers, Policymakers:

Anna Fallieras(203) [email protected]