Payment Reform

It's not easy getting an idea, let alone a project, off the ground. It's even harder keeping it afloat. The Aligning Forces for Quality New Mexico Alliance, and its partnership with New Mexico's state Medicaid office as well as other state leaders, provides an interesting example of how the public and private sector worked together to test an innovative payment reform model that may serve as an example to other states seeking to boost administrative efficiency.

Launching a new model of health care payment while adapting to a changing health care landscape takes time and...

 “As a result of funding from the Robert Wood Johnson Foundation through Aligning Forces for Quality (AF4Q), we are cultivating the land for a change that needs to happen. A change that is going to happen,” said Patricia Montoya, project director of the Albuquerque AF4Q Alliance. 

Montoya and the AF4Q initiative in Albuquerque, led by the Albuquerque Coalition for Healthcare Quality, are working with local health plans that have volunteered to work with the Alliance on a bundled payment pilot as part of their payment reform work. The work is very timely as...

If you’re in the market for a new car, it’s easy to find out if, say, a Toyota costs more than a comparable Chrysler. In fact, a small amount of research can help a consumer compare prices on just about any good or service in America.

The exception: health care. If you need a hip replacement, diabetes treatment, or heart surgery, and you want to know how much you will have to pay, you’re likely out of luck. Health care costs in America are such a mystery that often even doctors and most people who work in hospitals or clinics don’t know what they’re...

The Maine Health Management Coalition (MHMC), a partner in AF4Q Maine, wanted to encourage its members to seek care from the high quality, cost-effective providers MHMC identified. But MHMC encountered three problems:

  1. getting people to use the publicly reported quality information, 
  2. helping labor and management to see eye-to-eye on changing benefits to get care at a better...

In the rapidly changing landscape of health care delivery in the United States, one thing is becoming clear: Stakeholders, from purchasers to payers, are looking to alternatives to the fee-for-service payment scheme that will move the market toward safer, higher quality, affordable health care services.

The Memphis Business Group on Health (MBGH), a coalition of employers that is a founding Board member of the Healthy Memphis Common Table and a leader in the Common Table’s AF4Q initiative, has already been working to find a different...

 

Accountable Care Organizations (ACOs) have the promise to transform how health care is delivered by sharing financial awards among providers that realize savings in health care spending while improving quality. This article reviews the October 2011 regulatory policy statements related to the Medicare Shared Savings Program, clarifying some policies and altering others.

The Aligning Forces for Quality November 2011 National Meeting was held in Washington DC and was broken up into three distinct tracks: Payment, Care Across Settings, and Cost.  View video highlights on discussions and lectures below!  

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The Puget Sound Health Alliance and the State of Washington launched a multi-payer medical home pilot on May 1, 2011. The pilot, which includes eight medical groups with 12 locations with approximately 25,000 patients, is designed to restructure incentives to improve outcomes. In this pilot, primary care practices may receive an additional monthly fee per patient to support work that normally does not get reimbursed in a fee-for-service payment model, such as care coordination, increasing flexible...

On July 27, 2011, the West Michigan Aligning Forces for Quality Alliance brought together approximately 50 people who collectively represented the purchasers, payers, providers and consumers to discuss opportunities for health care payment reform in their community. Mr. Harold Miller, Executive Director of the Center for Healthcare Quality and Payment Reform and President and CEO of the Network for Regional Healthcare Improvement (NRHI), presented an overview of payment reform—why it is needed, as well as several examples of payment mechanisms better constructed to foster both...