Payment reform gets real

Thursday, March 01, 2012 12:19 PM

Chet Seward, Senior Director, Health Care Policy

Cuba Gooding Jr.’s famous “show me the money” line in the movie Jerry McGuire underscored his confidence in his abilities as a football player and his frustration with the NFL’s flawed contract system. Many physicians are similarly struggling with the health care payment system. Rather than rewarding care coordination, quality improvement and patient-centeredness, the current fee-for-service model often penalizes physicians for doing what’s right for patients.

Not for long.

The January/February issue of Colorado Medicine introduced the concept of practice evolution, which aims to help you and your practice identify necessary changes and implement plans to achieve success in the ongoing transformation of the health care system. Practice evolution can be broken down into four key areas: payment reform, transparency, delivery system redesign and administrative simplification. Together, these elements provide a framework for understanding the needs of our health care system today, and in the future.

In this issue, we zero in on the payment reform component of practice evolution and debunk the myth that payment reform will only happen in the future. Our interviews with major private and public health plans show that carriers are actively exploring or have already rolled out alternative reimbursement methodologies for physicians across the state. We asked several Colorado health plans about their new payment models, how that payment model ties into their strategic plans and what methodologies and measures they are using within these models to evaluate physician performance. On pages 20-23 you will find a grid that summarizes responses from Anthem Blue Cross Blue Shield, Cigna,
Kaiser Permanente, Colorado Medicaid, Rocky Mountain Health Plans and UnitedHealthcare.

These initiatives suggest that payment reform is here to stay. But what does that mean for physicians? On pages 25 and 27 Denver vascular surgeon Alan Synn, MD, and Aurora internist Alan Aboaf, MD, discuss whether Colorado physicians are actually ready for reform and hint at ties to broader practice evolution issues than just payment reform.

The Center for Value in Health Care (CIVHC) is stepping up efforts to coordinate statewide payment efforts that will accelerate changes and drive Colorado toward “Triple Aim” objectives to improve population health, enhance the patients’ experience of care and bend the per capita cost curve. CIVHC Payment Reform Implementation Work Group member Alan Kimura, MD, details current work and makes the case for significant physician involvement in these initiatives.

It is important for physicians to familiarize themselves with the various health plan payment reform programs. It is challenging for most physicians to make practice changes for just one payer. But by focusing on opportunities that apply across multiple programs, these changes can be more meaningful and incorporate redesigning workflow, aggregating appropriate data and utilizing similar performance metrics.

Whether or not you are currently eligible for these programs, it is important to remember that the health care system is indeed changing. It’s changing because the status quo is unsustainable. Your practice must change with it in order to meet the needs of your patients and the community. Are you ready?

What you can do now
The health plan payment reform grid on the following pages underscores the need for a set of core competencies and capabilities that all physicians must have, no matter your practice or employment setting, in order to thrive in the future. Consider the following:

• Invest in electronic medical record and other information systems.
• Appreciate the fact that performance assessment methodologies (as flawed as they may be) are becoming more prevalent through the use of clinical and claims data. Payers, as well as patients, will utilize this information to assess which physicians are performing at the highest levels.
• Gather data on how you compare locally or nationally to your peers. Collect and use your own performance information and compare that to the information provided by payers.
• Build or align yourself with a high-performance health care team. Teams beat individuals in performance because they can broadly and continuously manage complexity.