12-Conclusion: Shifting Payments from Volume to Value

MODULE 9 | Section 12 of 12

Conclusion: Shifting Payments from Volume to Value

MODULE 9 SUMMARY

“Payment reform should focus not on manipulating greed, but on dampening it,” suggests Drs. David Himmelstein and Steffie Woolhandler.31 “Then the real motivations for good doctoring—altruism, social duty, and the glow we feel when we help our patients—can flourish.”

 

This module reviewed numerous payment models that can begin to move US health care from paying simply for volume (fee-for-service) to paying for value. While there is some controversy about what level payments should be bundled, all of these newer payment models share tying payments to measures of quality and/or outcomes, and focus on the need to better coordinate and streamline care for patients.

MODULE 9 SECTION SUMMARIES

SECTION 2

Wasteful practices like ordering unnecessary tests are often rationalized by, “Better safe than sorry,” but should this kind of practice be perpetuated, and should patients have to pay for low-value, wasteful care?

SECTION 3

This section reviews health care costs and terms before diving into the rest of this module’s content.

SECTION 4

Fee-for-Service, the predominant payment model in the US, is reviewed and critiqued.

SECTION 5

There are a spectrum of alternatives to the fee-for-service model and one such, the Pay for Performance of P4P model is explored.

SECTION 6

Bundled payment models have shown good results and can be structured in ways to ensure the most value is provided while maintaining the model’s sustainability.

SECTION 7

Capitation and global payments provide bundling at the population level, on a “per head” basis or for a certain amount of time respectively. The pros and cons of these models are explored.

SECTION 8

Combinations of payment models may be necessary in order to limit barriers, overcome negative effects, and maximize value.

SECTION 9

Value-Based Insurance Design (VBID) is yet another method of ensuring high-value care, and is specific to each patient based on his or her needs. This method is interesting in that it works with insurance to lower the cost of the highest-value care for the patient.

SECTION 10

The Centers for Medicare and Medicaid Services introduced the Bundled Payments for Care Improvement Advanced (BCPI Advanced) model, which has been tested by several institutions. The results of some are discussed.

SECTION 11

Learners are walked through an analysis of episode-based bundled payments and asked to apply concepts of these models to different payment methods.

Learn More

ARTICLE

Read this article that explores the potential benefits and risks of bundling care.

Frakt, A. The New York Times. Sept, 2018.

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