Payment Systems for Future Healthcare Delivery

Payment Systems for Future Healthcare Delivery

1. Will the shared risk methodology work in the future health care delivery model?

2. We are continuing our examination of risk contracting and mitigation. This is an important area in health care as we continue our struggle to control cost in this country, yet increase the quality and outcomes. What role does Shared Risk Contracting methodology play in payment reform? Consider the current challenges of Population Health and the increasing patient volume and potential increase of High Risk patients entering our health care delivery system.

3. Based on your knowledge of Accountable Care Organizations (“ACOs”) offer your recommendation for the type of contracting would be most suitable. As you consider your recommendation from a 360 degree perspective, complete a SWOT analysis of your assessment.

4. ACOs are continuing to gain momentum as the model to be implemented. As health care leaders we will need to gain a better understanding of this model and how it will impact all parties (payers, providers and other health care institutions). More importantly we will need to understand the mechanisms of this model and the reimbursement models associated with ACOs and their ability to mitigate risk. What contracting methodology will likely be effective in an ACO environment? How will this methodology mitigate risk to ACO participants?

5. Much discussion has centered on designing the appropriate incentives to change provider behavior relative to improving patient care and outcomes, and thus creating “value”. From your own health care experience how will pay-for-performance (P4P) impact not only patient care, but also resulting contract rates?

6. Health care institutions and providers will continue to face challenges as the US health care delivery systems transform. The cornerstone of these challenges will involve improving the quality of care, while creating value. With this transformation a greater emphasis will be placed on providers to demonstrate their overall clinical performance in caring for patients (e.g., clinical care models, evidence based medicine and others). How will pay for performance contracting methodology impact and influence risk to a health care institution?

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