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Thursday, February 4, 2010
Why Payment Reform and What Are We Doing About It? Part 2
This is the second piece in a two part series about health care payment reform. Part one is available at NH Health Care Town Hall, where you can sign up to receive announcements about new blog pieces. Also, we invite you to follow the Citizens Health Initiative on Twitter and become a fan on Facebook.
By Heather Staples, NH Citizens Health Initiative Staff
As I mentioned earlier, the NH Citizens Health Initiative Payment Reform Pillar has many active stakeholders who represent provider, hospital, insurance carrier, and policy groups. There is strong consensus among these stakeholders that payment reform is the appropriate, overarching vehicle for rehabilitating health care. The manner in which we currently pay for health care is exclusively focused on volume (more services), and not on outcomes (whether the service helped, and in fact improved, the patient’s health).
Governor Lynch included payment reform as a priority in his January 21, 2010 State of the Union Address. The Governor supports a set of Payment Reform/Accountable Care Organization (ACO) pilots that will be launched early this year in collaboration with the major insurance carriers. Understanding how ACOs will operate and how they can reduce the State’s health care costs while maintaining or improving quality and outcomes is still being researched. The use of pilots will allow tracking, evaluation, and assessment to be done throughout the process allowing NH to assess the effectiveness in both the short and long term.
The pilot participants will be accountable for the care provided in their community, and will receive a global payment for managing the health of the population. Entities which make up an ACO can be varied but should comprise of a community of providers that can manage the full continuum of patients’ care, from preventive services to hospital based and nursing home care (specialists, hospitals, home health, etc). In NH, the Primary Care Medical Home pilots would be under the umbrella of an ACO.
To be an ACO, an organization must demonstrate proficiency in a number of areas including:
• Maintaining and accessing complete records of services on patients;
• Coordinating care;
• Functioning as a team;
• Offering options for patient self-management;
• Ability to measure and report on quality;
• Infrastructure and skills for managing financial risk;
• Commitment by leadership to improving value as a top priority, and a system of operational accountability to drive performance. (How to Create Accountable Care Organizations, Center for Health Care Quality and Payment Reform, 2009)
The intended outcomes from the pilot include:
• Better health care cost and better quality outcomes;
• More tightly coordinated care;
• Greater efficiency in health care service delivery;
• More appropriate care – “RIGHT” utilization;
• Lower health care service unit costs;
• Increased transparency;
• Higher levels of customer satisfaction.
The New Hampshire pilots will represent early, ground-breaking steps in our effort to be a top performing state, comprised of top-performing systems. New Hampshire is taking a strong and important lead in national health reform with these efforts.
For more information on the pilot, please visit www.citizenshealthinitiative.org or contact Heather Staples at 603.491.2701.