Rich Daly, HFMA Senior Writer/Editor
The importance of including patients in discussions of healthcare payment reform is among the early lessons of the new network.
March 25—A White House initiative to transform the way health care is funded in order to drive improvements has garnered the support of most of the nation’s largest insurers.
The Obama administration held a March 25 inaugural meeting at the White House of the Health Care Payment Learning and Action Network, which aims to spur the sharing of successes and failures in healthcare payment reform among healthcare providers, patients, and payers.
Administration officials underscored the importance of having garnered support for the initiative from seven of the 10 largest private insurers.
“We have examples where one payer or purchaser makes changes and then the provider is living in two worlds, which makes it incredibly difficult to succeed—where they decrease admissions on one side and in the new payment model they succeed, but in the fee-for-service model they are financially losing,” Patrick Conway, MD, deputy administrator of the Centers for Medicare & Medicaid Services (CMS), said during the meeting. “The point is to align on goals in our approaches.”
About 2,800 individuals and organizations have registered to participate in the network’s information sharing since its January launch. Conway underscored that the seven large private insurers, together with Medicare and Medicaid, cover more than half of the nation’s population.
Coordination between payers is becoming increasingly important to minimize conflicts as more providers move into quality-based payment systems, according to several speakers at the event, which included representatives from many national payer and provider advocacy organizations.
Nancy Beran, MD, chief medical officer at Westchester Health, Thornwood, N.Y., told attendees that quality incentives have to be aligned across payers.
“When those incentives are not aligned, these payment models fail,” Beran said.
The network’s goals specifically include developing “common approaches to core issues such as beneficiary attribution, financial models, benchmarking, quality and performance measurement, and risk adjustment,” according to a CMS fact sheet.
The shared approaches to payment reform that the network aims to foster among payers are “great examples of the partnership that can be had between the public and private sector,” said Bruce D. Broussard, president and CEO of Humana, which covers about 20 percent of Medicare Advantage and Part D beneficiaries.
Early Lessons
The initiative plans to hold “frequent” online meetings between interested parties to share best practices and progress reports on moving from a fee-for-service payment system to one that pays based on the quality of care delivered.
The value of such broad-based information sharing was among the early lessons noted by participants in the network. For example, Delaware Gov. Jack Markell, a Democrat, told attendees that a similar effort to convene healthcare stakeholders and share ideas over the last two years drove payment reform in his state. Delaware’s initiative aims to shift 80 percent of healthcare spending to payment models that reward quality and efficient care, and to cut the growth of healthcare spending by up to two percentage points.
“This is the best opportunity we will have in a long time to achieve the triple aim” of improved patient experiences, improved population health, and reduced costs, Markell said about the White House-led network.
The state’s effort reflects recent initiatives announced by CMS and private payers to similarly move large shares of their payments from fee for service to value-based systems.
Debra Ness, president of the National Partnership for Women & Families, said previous experience with new payment models has shown the importance of including patients and their families in discussions on redesigning healthcare pay structures.
“We can’t expect to get to a system that meets that triple aim, that meets the needs of patients and families, if they are not there at the table helping to shape that design,” Ness said.
Source: HFMA
https://www.hfma.org/Content.aspx?id=29230