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

Given the aging population, Healthcare programme reimbursement cuts, government deficits, dwindling earnings, poor health status, it is conceivable to think of a future health model that focused on affordability while improving on doing more with less and achieving high levels of patient care quality.

Do you think the following describes the likely attributes of s future healthcare model? If yes then use the as a basis for developing more thoughts.

1.1 The Future Model likely models
1.1.1. Reducing costs demonstrated by reduction in the highest drivers of health care costs. What are some key drivers of health care costs? Hint: compare the cost when a patient is admitted vs. treatment as an outpatient or visiting an emergency room, the cost of medicines and laboratory tests.
1.1.2. Increasing efficiency demonstrated by achieving more with less resources
1.1.3. Increasing quality of care
1.1.4. Better health outcomes

1.2. According to various authors (Melnick 2012, Guy 2011) (please read) The shared risk model is aimed at sharing the risk of patient care by:
1.2.1. Sharing of savings realized from patient care costs,
1.2.2. Bonus to providers who improve quality,
1.2.3. Encouraging primary preventive ambulatory care such as home care e.g. Patient Cantered Medical Homes as opposed to inpatient and or repeated hospitalizations

1.3. There are examples of models which have achieved success in combining 1.1 and 1.2 (Sacramento 2012, Vermont Blueprint for Health 2008, Group Health Cooperatives study 2009, Blue Shield of California and Partners 2007)( Melnick 2012)
On this basis can you Shared Risk will work in future Healthcare delivery Models then?

2. What role does Shared Risk Contracting methodology play in payment reform?

Here are some notes on Shared Risk contracting for you to form an opinion as well

2.1. Will help coordinate how Payment plans will focus on cost savings, quality of care, demonstration of outcomes, and continuity of care. How does this impact on payment reform?
2.2. Better data collection help coordinate both Medicare and Medicaid. Think of the importance of data in payment reform
2.3. Payment savings will be realized as there will be incentive (What is the incentive here? Think of bonuses!)
2.4. Reduction in wastage as there will be ...

Solution Summary

Future Healthcare delivery systems will need to provide better quality care at lower cost i.e being more efficient yet more robust than they are today.

There is a need for refor to in the payment system which will involve all the players in ACOs.
This guideline provides insights into future healthcare delivery payment systems and the implications on both patient care and costs