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At-risk for results: guaranteeing performance based on patient outcomes
1MCC Behavioral Care, Eden Prairie, MN, USA.
Behavioral Healthcare Tomorrow
|March 8, 1997
Summary
Managed care organizations can use outcomes-based reimbursement to overcome price-focused purchasing. This requires developing robust information systems and measurement infrastructure for successful implementation.
Area of Science:
- Health economics
- Healthcare management
- Outcomes research
Background:
- Purchasers often prioritize price over value in managed care.
- Managed care organizations (MCOs) face pressure to demonstrate value beyond cost.
- Existing reimbursement models may not adequately capture healthcare quality or patient outcomes.
Purpose of the Study:
- To explore outcomes-based reimbursement arrangements as a strategy for MCOs.
- To identify the necessary infrastructure for implementing such arrangements.
- To examine purchaser interest in specific outcomes and proposed reimbursement models.
Main Methods:
- Conceptual analysis of managed care economics and reimbursement strategies.
- Review of literature on outcomes measurement and healthcare purchasing.
- Discussion of proposed outcomes-based reimbursement models.
Main Results:
- Outcomes-based reimbursement can shift focus from price to value.
- Development of information systems and outcomes measurement is crucial for MCOs.
- Purchasers are interested in specific clinical and patient-reported outcomes for reimbursement.
Conclusions:
- Outcomes-based reimbursement offers a viable alternative to price-driven purchasing in managed care.
- MCOs need to invest in data infrastructure to support value-based contracting.
- Further exploration of provider-MCO outcomes-based arrangements is warranted.