Value-Based Payment Strategies for Patients with Complex Health and Social Needs

December 2017

On December 19, 2017, the Playbook convened payment experts to examine questions many health care organizations are asking:

  • How does my organization get paid to care for the complex health and social needs of my most at-risk patients?
  • What do we know about existing or emerging value-based payment strategies for this population?
  • How can my organization use these new models to improve how we deliver care?

This interactive online discussion, moderated by Don Goldmann, MD, Chief Scientific Officer, Emeritus, and Senior Fellow at the Institute for Healthcare Improvement, provided opportunities to share ideas and ask questions about how payment reform strategies can be leveraged to improve care for people with complex needs. Panelists provided perspectives from both the national and state levels, as well as from public and private purchasers.

Here were a few of the takeaways:

  • Delivery reform is top of mind for Medicaid directors, said Dianne Hasselman, MSPH, of the National Association of Medicaid Directors. Forty percent of Medicaid directors said they were prioritizing delivery reform, such as ACOs and patient-centered medical homes. In addition, nearly every state took action to move patients from institutional settings to home and community settings in 2017.
  • States, while moving headfirst into value-based payment, have made less progress with complex needs patients, said Michael Bailit, MBA, of Bailit Health. One reason for this is that many patients with complex needs use long-term services and supports outside the traditional health care system. These tend to be very small “mom and pop” organizations without data and measurement capabilities to assess performance.
  • There’s a lot of experimentation with payment reform, but we’re not yet sure what’s working, said Suzanne Delbanco, PhD, of Catalyst for Payment Reform. The fastest growing category of payment reform seven years ago was pay for performance, but now shared savings has become the most prevalent alternative payment model.

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