Colorado is one of four states that partner with Medicare to try to pay doctors based on their ability to maintain patient health, but it’s not clear how to do that.
The idea that insurers can keep costs down by encouraging types of care that people will not need costly procedures in the future is not new, and Medicare has incentives and money over the last decade. I have tried a combination of punishments.
Most people do not generate significant savings and have not shown to improve patient health. Also, the American medical system still relies primarily on billing for individual services.
Part of the reason why quality payment efforts have not been achieved so much is that Medicare, Medicaid and private insurers have their own different methods of measuring and paying for quality of care, co-directors said. Karen Joint Maddox said of the Center for Health Economics and Policy at Washington University.
This means that there is not enough momentum in one direction to change the way healthcare facilities do business at this time.
“Now it’s just a mess,” she said. “It’s moving, but it’s moving slowly and fragmentarily.”
Colorado health authorities believe that partnerships with the Federal Medicare and Medicaid Service Centers can help change that. Early in the process, but over the next few years, Colorado Medicaid (now called Health First Colorado) and Medicare will select specific areas of improvement and providers will focus on their priorities. Suit you.
If that works, Medicare may decide to adopt some or all of the Colorado models nationwide. Experiment with ideas to improve the quality of care in Arkansas, California, and North Carolina.
Mark McClellan, one of the Co-Chairs of the Centers for Medicare and Medicaid Services’ Health Care Payment Learning and Action Network, said he chose to work with Colorado and three other states because he has already paid for quality. rice field.
“We look forward to efforts in these states to serve as a model to help other states succeed in their efforts to pay for better health, improve quality of care and lower costs,” he said. Said in a statement.
Kim Bimestefer, Managing Director of Colorado’s Health Policy and Finance Department, said the partnership is one way to move from paying for each healthcare service provided by Colorado to a system that delivers better results for patients. He said it was just a method. She said she believes Colorado can build something more effective by seeing where other efforts are lacking.
“You get what you pay for and people focus on what you measure,” she said.
Monthly fee aimed at enabling flexible care
Stephanie Gold, president-elect of the Colorado Family Physician Academy, said the state began the second phase of its alternative payment plan in January. In the first phase, she said, the state paid an additional fee if the practice achieved certain goals, such as screening a high percentage of eligible patients with cancer that could be successfully treated during early diagnosis.
According to Gold, in the second phase, clinics that decide to attend can choose to set a monthly fee that is tailored to the complexity of the patient’s condition, ranging from 10% to 100% of Medicaid patients. increase. As before, you will be paid for each other patient’s service.
Assuming Phase 2 works, she said Phase 3 is likely to significantly expand the monthly payment model.
Monthly fees give you the flexibility to spend money on services that you wouldn’t normally be able to charge, such as replying to a patient’s email, getting a healthy meal, or arranging transportation. According to Gold, it also provides some stability in case the demand for services declines again, such as at the start of a pandemic.
During the summer, the state deployed drug comparison tools to allow prescribers to see which drug was preferred for its results and costs, according to Bimstefer. If the doctor enters an expensive drug, the system offers two low-cost options, if any. If the prescriber thinks one drug is the best, she doesn’t have to choose a low-cost option, she said. The state is still working on incentives to get providers to use it.
“Do you know what you’ll get if you pay for everything, whatever the outcome? She said in a department oversight hearing with lawmakers on January 27.
Difficult to change “the devil you know”
Medicare and other payers have tried several different ways to promote quality and keep costs down, Joynt Maddox said.
One model is to impose rewards or penalties on hospitals based on the patient’s behavior after admission. For example, have you had a secondary infection or have you returned within a few weeks due to complications? While these plans may have resulted in “minimal” cost savings and encouraged hospital leaders to focus on preventing harm, the odds of a patient dying after treatment have not changed, she said. rice field.
“They don’t fundamentally confuse how care is delivered or paid,” she said.
Another major attempt by Medicare and other insurers is to try to limit the cost of patient care during the year, Joint Maddox said. This can be done by paying a monthly fee for the medical practice responsible for people’s care (that is, reducing care costs so that savings can be maintained), or spending and rewarding goals if the healthcare provider hits it. Includes setting.
Plans to pay a monthly fee, often referred to as an accountable care organization, have been “somewhat successful” in producing subtle improvements in quality and cost savings, Joint Maddox said. However, she said that patients may not always get what they need, and it may be as easy as a designated staff member checking in on a regular basis.
“It’s all reactive medicines,” she said.
Medicaid, Medicare, state-regulated commercial insurance plans, and federal-regulated large-scale employer plans all have different priorities for improving quality, or different ways of measuring essentially the same priorities. It is difficult for practices to satisfy everyone because of the potential.
Health providers are, of course, concerned about plans that they could lose money on, and there is no agreed way to determine how complex a patient’s needs are.
“I think it’s widely understood that service charges are a flawed payment system,” she said. “I think there are a few’devils you know’.”
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