Health Care Homes and Payment Reform

Ross Owen, M.P.A.BHCAG Workshop6/21/12

Multi-Payer Investment in Primary Care Transformation

SOURCE: Adapted from MDH Health Economics Program, Medicare enrollment data and SEGIP

enrollment data

Payment Approaches to Support the HCH

Fee-for-Service

Fee-for-Service + Budget-

Neutral HCH Payment Shared

SavingsShared Savings

and Shared Losses

Global Payment

Reimbursement Models

Provider Economic Incentives

Deliver More Care

Reduce Costs, Improve Quality Outcomes and

Experience

“Accountable Care/Total Cost of Care”

HCH Payment Within Accountable CarePublic purchaser ACO models embed

HCH payment within calculated costs◦Medicare Shared Savings Program◦Pioneer ACO◦MN Medicaid Health Care Delivery

Systems DemonstrationCore HCH elements considered

foundational to ACO definitions◦NCQA ACO accreditation criteria◦Primary care as the locus of patient

attribution

Primary Care is the Foundation of Accountable Care

Miller, Harold. Center for Healthcare Quality and Payment Reform:http://www.chqpr.org/downloads/HowtoCreateAccountableCareOrganizations.pdf

Value to PurchasersPublic budgets assume neutrality for direct

HCH payments: “no new money” A ready-made “blue ribbon” designating

advanced primary care models in your backyard◦ Selective Contracting

◦ Tiered Networks

◦ Direct Financial Support for non-Visit Based Care

Evidence that care coordination is most effective the closer it is to the setting of care

More work to do to demonstrate both short- and long-term return on investment (ROI) for commercially-insured

Changing Role of PurchasersIncreasingly active role in

designing and influencing provider reimbursement models

Comparing value of available coordination/support services

Aligning incentives for patients and providers with the desired outcomes (e.g. deductibles)

QUESTIONS?