WASHINGTON — Policymakers need to launch a “Manhattan Project” to help healthcare providers transition to accountable care organizations (ACOs) and other alternative payment models, a health policy expert said.
Although hospitals, physicians, and other healthcare providers understand the need to move away from fee-for-service, many are unsure of how to do it, are unable to do it, or are trying to figure out how best to do it, Len Nichols, PhD, director of the Center for Health Policy Research and Ethics at George Mason University in Fairfax, Va., said here.
“I would assemble a team of outside and inside advisers to work out the math of the road map and give it away as a public good,” Nichols said at an Alliance for Health Reform briefing Friday on healthcare cost containment.
The road map must be usable by different groups of providers, yet come from a public-private partnership so payers like Medicare and the numerous private health plans out there can all use it.
Want to publish your own articles on DistilINFO Publications?
Send us an email, we will get in touch with you.
“This rough road map is being worked out in both public and private pilots and demos and, in some cases, programs as we speak,” Nichols said. “It is this road map — or maybe you can even think of it as a blueprint — that we need to construct in ways that work for heterogeneous providers and plans in our mostly private healthcare system.”
With regard to Nichols’ point about how to make abstract ideas like ACOs and patient-centered medical homes a reality, more than a half dozen reports released in the last year from think tanks on healthcare cost containment all suggested the need to move away from fee-for-service.
“How do you get there? Those reports are silent,” Paul Ginsburg, PhD, president of the Center for Studying Health System Change, said. “That was unfortunate.”
Ginsburg, also speaking at the Alliance event, noted that innovative payment approaches are still very crude, and many providers aren’t capable of succeeding under these reformed payment approaches. “For reforming payment to really work, there has to be some degree of coordination between what Medicare and Medicaid are doing and what private payers are doing,” he said.
Each man noted ongoing efforts to repeal Medicare’s sustainable growth rate (SGR) payment formula as a great way to spur medical innovation. However, the goals of the SGR weren’t too much different than what they are for these different payment models, Nichols pointed out — to hold down the growth of medical spending.
That’s why more enforcement efforts are needed from Congress as these are enacted, to make sure they hit their goals, he said.
Date: Dec 16, 2013