90% of health plans think the use of alternative payment models will increase in the coming years

A recent report from the Health Care Payment Learning and Action Network (HCP LAN) examines how providers are getting paid in the U.S. today.  Traditionally, health care providers (e.g., physicians, hospitals) were paid via fee-for-service (FFS).  Fee-for-service means that every time a provider does a service, they get paid.  This is truly largely regardless of…

Do we need Hospital Compare if we have Yelp?

This is basically the question that Perez and Freedman (2018) ask.  They find the following: Among crowdsourcing sites’ best‐ranked hospitals, 50–60% were also the best ranked on [Hospital Compare’s] HC’s overall and patient experience ratings; 20% ranked as the worst. Best‐ranked hospitals had significantly better clinical quality scores than worst ranked hospitals, but were not…

When is physician failure a good thing?

How do physicians learn?  A paper by Van Gestel, Muller, and Bosmans (2018) claims that the answer is through cumulative experience, economies of scale, or human capital depreciation. Learning from cumulative experience refers to the idea that treating an additional patient generally improves physician (or team) performance. When referring to economies of scale, we capture…

Will Medicare Advantage be the future of Alternative Payment Models

CMS has focused in recent years on payment reform–especially alternative payment models–in Medicare’s fee-for-service (FFS) reimbursement system, but much less has been paid to beneficiaries enrolled in Medicare’s managed care program (i.e., Medicare Advantage).  Currently, however, more than 1 in 3 beneficiaries are enrolled in an Medicare Advantage plan, and by 2028 that number could…

The Status of Outcomes-Based Contracts

Outcomes-based contracts are supposed to be the next big thing.  When payers are not sure about the real-world benefits or cost of a treatment, outcomes-based contracts and help them diversity risk. For instance, CMS will only pay for the CAR-T product  Kymriah when “…these patients respond to Kymriah by the end of the first month…

Why hasn’t public value reporting led to more patients choosing high value care?

CMS has a number of quality initiatives to measure provider quality.  For instance, there is the Hospital  Inpatient Quality Reporting Program, the Home Health Quality Reporting Requirements, the Skilled Nursing Facility (SNF) Quality Reporting Program, the Inpatient Rehabilitation Facilities (IRF) Quality Reporting Program (QRP), among others.  Have these initiatives led to more patients choosing high value care? …