This toolkit is tailored specifically to ACAP member plans that are interested in implementing an episode-of- care payment (sometimes called bundled payment1) with their contracted providers to improve quality of care and reduce the costs associated with unnecessary care. This Toolkit provides interested ACAP members with relevant information to implement an episode-of-care program and is meant to guide Medicaid plans with step-by-step instructions on what analyses should be conducted and what considerations and decisions need to be made in order to begin a successful episode-of-care program.
The CAPG is pleased to release a special publication, CAPG’s Guide to Alternative Payment Models. This book of case studies highlights CAPG members’ robust experiences with a range of APMs, from bundled payments to capitated, coordinated care. The vignettes highlight the payment foundation for risk-based coordinated care in Medicare, Medicaid, and commercial health plan relationships with physician organizations. Each study describes the payment model at the group or organization level and the individual physician level, along with successes and areas for improvement for the model.
CPR, in partnership with the Urban Institute, released Payment Methods and Benefit Designs: How They Work and How They Work Together to Improve Health Care. Within these reports, they offer detailed discussions of how payment methods and benefit designs can work together to align the incentives on the provider side and the consumer side to support delivery system reform. In particular, they examine which payment methods and benefit designs, in unison, could best support accountable care organizations, patient centered medical homes, and “focused factories,” a uniform approach to delivering efficiently a limited set of high quality services.” To think through these complex combinations, CPR and the Urban Institute also dove deep into the nuances of nine payments methods and seven benefit designs, where we reviewed their strengths and weaknesses, ways to mitigate the weaknesses, how they pair with themselves and each other, and more. In addition, they organized both methods into separate typologies to help array the options in the marketplace today.
The Health Care Transformation Task Force’s Work Group on Improving Care for High-Cost Patients recently released the third and final in a series of white papers, entitled “Payment to Promote Sustainability of Care Management Models for High-Need, High-Cost Patients.” It outlines emerging payer and provider partnerships that incentivize sustainable delivery system re-engineering to improve care through innovative value-based payment models. It finds that the fee-for-service payment system has and continues to impede broad adoption of effective interventions for high-need, high-cost patients. Further, it notes that conflicting requirements and methodologies from multiple payers threaten to hinder progress in the future, even in supportive environments.
The, Health Care Transformation Task Force is a consortium of patients, payers, providers and purchasers working to transform the U.S. health care system. Its first and second papers can be accessed at www.hcttf.org.[/vc_column_text][/vc_column][/vc_row]