Francois de Brantes

Reaching the goals set by the Health Care Payment and Learning Action Network requires an unyielding and unrelenting focus on encouraging providers to adopt advanced alternative payment models (APMs). Many of these models will continue to be voluntary because they either are in early stages or have not yet proven their effectiveness. The models that have proven their effectiveness should become permanent, comprising the new way that providers are paid in the Medicare program. Either way… Show more

Reaching the goals set by the Health Care Payment and Learning Action Network requires an unyielding and unrelenting focus on encouraging providers to adopt advanced alternative payment models (APMs). Many of these models will continue to be voluntary because they either are in early stages or have not yet proven their effectiveness. The models that have proven their effectiveness should become permanent, comprising the new way that providers are paid in the Medicare program. Either way, getting today's high performers into those programs and keeping them engaged to continue to innovate and set new benchmarks is as important as attracting and improving the performance of poorer performers. That will require a shift in Medicare's policy on pricing and evaluating APMs. Show less

To accelerate wider adoption of the health care warranty, stakeholders will need to refine the allocation of risk between payer and provider while simultaneously minimizing the real or perceived uncertainty for providers. This must be done through a contract that binds buyer and seller in ways that will align incentives. The authors define a warranty as an implicit acceptance by providers to bear the cost of any complications related to the management of a procedure or condition. So, when… Show more

To accelerate wider adoption of the health care warranty, stakeholders will need to refine the allocation of risk between payer and provider while simultaneously minimizing the real or perceived uncertainty for providers. This must be done through a contract that binds buyer and seller in ways that will align incentives. The authors define a warranty as an implicit acceptance by providers to bear the cost of any complications related to the management of a procedure or condition. So, when providers accept a fixed budget or price for a patient’s total care for a condition or procedure, they are offering an implicit warranty on that care. Current models that strive for a warranty blur the line between risk (which is measurable) and uncertainty (which is not measurable). The authors offer specific design elements for Warranty-Based Alternative Payment Models. Show less

The Health Care Incentives Improvement Institute collaborated with Community Health Choice, a 350,000-member nonprofit Medicaid HMO in southeastern Texas, to design, implement, and measure a maternity-care bundled-payment pilot program. First-year results of this 2-year effort show that bundled payments for maternity should include the costs and outcomes of pregnancy, delivery, and neonatal care — and that this type of model can help to achieve broader population-health and cost goals.

Health care in the US needs a cure, and this book provides one that can be implemented tomorrow. It's all about fixing the incentives that currently encourage doctors, nurses, hospitals and others to be bad instead of being what they want to be... good. It's a call to action for a new national project: delivering an effective and lasting cure to the American health care system.

In September 2009, we released a set of concrete, feasible steps that could achieve the goal
of significantly slowing spending growth while improving the quality of care. We stand by
these recommendations, but they need to be updated in light of the new Patient Protection
and Affordable Care Act (ACA). Reducing healthcare spending growth remains an urgent
and unresolved issue, especially as the ACA expands insurance coverage to 32 million more
Americans. Some of our reform… Show more

In September 2009, we released a set of concrete, feasible steps that could achieve the goal
of significantly slowing spending growth while improving the quality of care. We stand by
these recommendations, but they need to be updated in light of the new Patient Protection
and Affordable Care Act (ACA). Reducing healthcare spending growth remains an urgent
and unresolved issue, especially as the ACA expands insurance coverage to 32 million more
Americans. Some of our reform recommendations were addressed completely or partially
in ACA, and others were not. While more should be done legislatively, the current reform
legislation includes important opportunities that will require decisive steps in regulation and
execution to fulfill their potential for curbing spending growth. Executing these steps will not
be automatic or easy. Yet doing so can achieve a healthcare system based on evidence, meaningful choice, balance between regulation and market forces, and collaboration that will
benefit patients and the economy.
We focus on three concrete objectives to be reached within the next five years to achieve
savings while improving quality across the health system:
1. Speed payment reforms away from traditional volume-based payment systems so that
most health payments in this country align better with quality and efficiency.
2. Implement health insurance exchanges and other insurance reforms in ways that
assure most Americans are rewarded with substantial savings when they choose plans
that offer higher quality care at lower premiums.
3. Reform coverage so that most Americans can save money and obtain other meaningful benefits when they make decisions that improve their health and reduce costs.
We believe these are feasible objectives with much progress possible even without further
legislation. However, additional legislation is still needed to support consumers – including Medicare beneficiaries – in making choices that reduce costs while improving health. Show less

Objective
To determine the extent to which the size of the available financial incentive influences a physician's decision to participate in a pay-for-performance (P4P) program.
Study design
Statistical analysis of historical data from Bridges to Excellence (BTE).
Methods
Setting available financial incentives as the independent variable and physician participation rates as the dependent variable, we applied regression analysis to BTE's data from selected sites to explore the… Show more

Objective
To determine the extent to which the size of the available financial incentive influences a physician's decision to participate in a pay-for-performance (P4P) program.
Study design
Statistical analysis of historical data from Bridges to Excellence (BTE).
Methods
Setting available financial incentives as the independent variable and physician participation rates as the dependent variable, we applied regression analysis to BTE's data from selected sites to explore the relationship of fixed bonus-based incentive programs to physician participation rates in those programs.
Results
The amount of incentives available to physicians strongly affected their rate of participation. Participation rates varied with the type of program, and overall physician participation rates might grow as more purchasers/payers within a community offer similar incentives.
Conclusion
Our analysis suggests that all stakeholders--health plans, physicians, and patients--would benefit from health plans collaborating on their P4P efforts to maximize physician participation. Show less

How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persistent growth in health spending. Adding “warranties” to care is an innovation that transfers risk to providers, because payment includes allowances for defects. How do such warranties affect patient care and bottom lines? We examine a proposed payment model to illustrate the role of warranties in health care and their potential… Show more

How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persistent growth in health spending. Adding “warranties” to care is an innovation that transfers risk to providers, because payment includes allowances for defects. How do such warranties affect patient care and bottom lines? We examine a proposed payment model to illustrate the role of warranties in health care and their potential impact on providers' behavior and profitability. We conclude that warranties could motivate providers to improve quality and could increase their profit margins. Show less

Programmes to turn patients into active consumers have not yet lived up to their sponsors' expectations. While the business case for such programmes has been strong, their success has been hampered mainly by two factors. The first is a lack of robust and actionable messages that would create awareness of system-wide problems in healthcare and cause consumer-patients to act on those messages through decision-support tools. The second is an appropriate segmentation of the messages and… Show more

Programmes to turn patients into active consumers have not yet lived up to their sponsors' expectations. While the business case for such programmes has been strong, their success has been hampered mainly by two factors. The first is a lack of robust and actionable messages that would create awareness of system-wide problems in healthcare and cause consumer-patients to act on those messages through decision-support tools. The second is an appropriate segmentation of the messages and decision-support tools that would appeal to different types of consumer-patient. Show less