1 / 11

Special Commission on the Health Care Payment System

Special Commission on the Health Care Payment System. January 16, 2009 1:00 p.m. – 3:00 p.m. McCormack Building: Ashburton Café. Special Commission on the Health Care Payment System. Statute Overview. Overview.

Download Presentation

Special Commission on the Health Care Payment System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Special Commission on the Health Care Payment System January 16, 2009 1:00 p.m. – 3:00 p.m. McCormack Building: Ashburton Café

  2. Special Commission on the Health Care Payment System Statute Overview

  3. Overview • The Special Commission on the Health Care Payment System was created under Section 44 of Chapter 305 of the Acts of 2008. • Goal: Investigate reforming and restructuring the payment system to provide incentives for efficient and effective patient-centered care and to reduce variations in the quality and cost of care.

  4. Membership of Commission Ten-member Commission consisting of: Ex-Officio Members: • Secretary of Administration and Finance (co-chair) • Commissioner of the Division of Health Care Finance and Policy (co-chair) • Executive Director of the Group Insurance Commission Legislative Appointments: • 1 person to be appointed by the Senate President • 1 person to be appointed by the Speaker of the House Gubernatorial Appointments: • Massachusetts Association of Health Plans, Inc. • Blue Cross and Blue Shield of Massachusetts, Inc. • Massachusetts Hospital Association, Inc. • Massachusetts Medical Society • a health economist or expert in the area of payment methodology

  5. Responsibilities • Examine payment methodologies and purchasing strategies, including, but not limited to alternatives to fee-for-service models; • Recommend a common transparent payment methodology; and • Recommend a plan for the implementation of the common payment methodology across all public and private payers in the Commonwealth, including a plan for MA to seek a waiver from federal Medicare rules to facilitate implementation.

  6. Required Consultations • In making its investigation, the Commission is required to consult with: • Health Care Quality and Cost Council; • Health care economists; and • Other individuals or organizations with expertise in state and federal health care payment methodologies and reforms. • Before a final vote on any recommendations, the Commission is required to consult with “a reasonable variety of parties likely to be affected by its recommendations, including, but not limited to”: • The Office of Medicaid; • The Commonwealth Health Insurance Connector; • The Massachusetts Council of Community Hospitals, Inc.; • The Massachusetts League of Community Health Centers, Inc.; • 1 or more academic medical centers; • 1 or more hospitals with a high proportion of public payors; • 1 or more Taft-Hartley plans; • 1 or more self-insured plans with membership of more than 500; • The Massachusetts Municipal Association, Inc.; and • Organizations representing health care consumers

  7. Other Considerations • A majority vote of the Commission is required before any action is considered “official.” • Commission meetings are subject to the Open Meeting Law. • Ethics Laws Nancy Savoie – (617) 988-3210 or nancy.savoie@state.ma.us

  8. Special Commission on the Health Care Payment System

  9. Draft Principles for Health Care Payment Reform Base assumption: Significant reform of the provider health care payment system is required to significantly slow the high rate of health care cost growth. • Fee-for-service payment rewards overuse of services and therefore is not a preferred model for most provider payments. • Payments should be adequate to cover the costs of efficient providers and ensure adequate access to care for consumers. • Provider payment systems should reward the delivery of efficient, high quality health care that aligns with evidence-based guidelines. • The health care payment system should reinforce provision of the optimal level of care and care coordination across the spectrum of health care providers. • Payments should minimize the risk to providers for events largely outside of their control and should neither reward nor penalize a provider for accepting one patient rather than another (no incentives to “cherry pick”). • Health care payments should be uniform for specific services, on a risk adjusted basis, regardless of payer, to the extent that this is financially feasible for government payers. • The health care payment system should be organized in such a way as to minimize provider and payer administrative costs that do not add value.

  10. Special Commission on the Health Care Payment System

  11. Payment Models Referenced in Statute • Blended capitation rates • Episodes-of-care payments • Medical home models • Global budgets • Pay-for-performance programs • Tiering of providers • Evidence-based purchasing strategies

More Related