Alternative payment models: Top 4 trends to watch

The 2016 Alternative Payment Models in Healthcare Conference 2016 is shedding light on which healthcare payment and delivery changes are evolving into large-scale, long-lasting solutions.


The 2016 Alternative Payment Models in Healthcare Conference 2016, held March 17 to 18 in Orlando, Florida, is shedding light on which payment and delivery changes are evolving into large-scale, long-lasting solutions for the industry.  

From sessions evaluating the results of Medicare alternative payment initiatives, to those focusing on how healthcare policy and regulations are further propelling payment changes, here are some of the top trends highlighted at the conference.


MACRA’s Impact on Payment Reform

President Barack Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law in April 2015, and with its passage, established several payment changes.

"The new law contains provisions meant to consolidate and accelerate ongoing efforts to reform Medicare's physician payment system to reward higher quality and better outcomes rather than greater volume and intensity," Stuart Guterman, vice president, Medicare and Cost Control, The Commonwealth Fund, Washington, D.C., told Managed Healthcare Executive shortly after MACRA was signed.  

Matt DoBias, senior manager at the PwC Health Research Institute, and Igor Belokrinitsky, principal in the health industries practice at PwC, will further discuss how MACRA affects payment reform at the conference on March 17.

During their presentation, Advancing Opportunities for High Quality Care through Physician Payment Reform,” they will share how MACRA increases physician choice with new payment models, and could assist the overall implementation of alternative models.

“In many ways, MACRA genuinely reflects Medicare and Medicaid’s drive towards payments that are based on the quality of care physicians deliver rather than the quantity of procedures they perform,” DoBias recently told Managed Healthcare Executive. “The law creates two new payment streams beginning in 2018-one known as the Merit-Based Incentive Payment System (MIPS) and another focused on providers who are in an alternative payment model.”

For more on MACRA, read “How the SGR repeal will impact managed care.”




The Independence at Home Initiative

The Independence at Home Initiative (IHI), created in 2012, is a Centers for Medicare and Medicaid Services (CMS) program that encourages home-based care teams to target chronically ill Medicare patients. Program participants that provide high-quality care while reducing costs receive incentives.

Results of the first performance year of the IHI for all participants, according to CMS, include: 

  • Savings of more than $25 million-an average of $3,070 per participating beneficiary, and

  • Improved quality scores in at least three of six quality measures.

Peter A Boling, MD, professor and chair of geriatric medicine at VCU medical, a participant in the IHI, will further discuss the program during his March 17 presentation at the conference, “Independence at Home-Insights from Virginia on a Shared Savings Model in Home Based Primary Care.”

“In my opinion, the demonstration has shown great success to date,” Boling told Managed Healthcare Executive prior to the conference. “It is well targeted and has identified a pool of high risk of high-cost patients, and has a unique delivery model. In its first year, IAH has shown more savings than other demonstrations, along with high quality of care.”




Data’s Growing Role

Gathering the appropriate data on patient populations, and turning that data into actionable information, is-and will continue to be-a major challenge as plans and providers strive to succeed in alternative-based payment models.

When asked, "How well would you say your organization is using big data to improve healthcare quality and reduce healthcare costs?" only 10% of respondents to Managed HealthcareExecutive’s 2015 State of the Industry Survey respondents said, "very well, it's making a big impact."

For more, read “Top 5 industry challenges of 2016.”

Challenges associated with data-and the potential opportunities associated with fully using it- will be addressed at the conference.

During a panel discussion at the conference, “Cultivate Optimal Quality Metrics and Outcomes Data to Prove Alternative Payment Model Success,” stakeholders will explore strategies for analyzing available data to determine improved patient outcomes, including predictive analysis, to allow for enhanced contracting for new models.




Patient Engagement as a Game Changer

As new payment models require improved care quality at reduced costs, patients will be key in helping plans and providers succeed.

Jonathan Slotkin, MD, medical director of Geisinger in Motion, a Geisinger Health System program that promotes the effective use of technology to initiate patient and provider activation across a distributed healthcare delivery network, recently told Managed Healthcare Executive that the key to increasing patient engagement is making it easy for them to engage.

In other words, explore how the tools patients use in everyday life, such as smartphones, tablets, and wearable devices, can lend a hand in increasing patient engagement.

“Our goal is to integrate patients' needs related to healthcare into their normal routines, including their daily use of digital technology,” said Slotkin. “If we can add healthcare to the list of other items they use technology for, we have a better chance of engaging them and increasing care adherence.”

For more, read: Five ways technology can increase patient compliance

During the session, “Engage and Activate Patients in Alternative Payment Models through Clinical Decision Support Initiatives and Technologies,” at the Alternative Payment Model in Healthcare Conference 2016, Creagh Milford, president, population Health Services, at Mercy Health, will further explore how new technology that can activate patients, such as virtual visits and patient portals, can improve patient health.

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