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Payment models to support population health management
Advances in Health Care Management
|January 29, 2015
Summary
Policy-driven financial controls can improve population health management (PHM) by shifting from volume to value-based care. However, standardized quality measurement is crucial for successful implementation of these payment reforms.
Area of Science:
- Health Services Research
- Health Economics
- Healthcare Policy
Background:
- Physician behavior is increasingly influenced by financial incentives and policy changes.
- Population health management (PHM) initiatives aim to improve health outcomes for defined patient groups.
- Current healthcare payment models present challenges to effective PHM.
Purpose of the Study:
- To examine policy-driven financial controls influencing physician practice patterns in population care.
- To review existing healthcare payment models and their impact on PHM.
- To propose a multi-part payment model to enhance PHM.
Main Methods:
- Review of current healthcare payment models.
- Analysis of the impact of payment models on PHM initiatives.
- Presentation of a hybrid payment model combining fee-for-service, care coordination payments, and performance-based incentives.
Main Results:
- A multi-part payment model can reduce volume-based incentives and boost efficiency.
- The success of such models depends on a pay-for-performance framework with standardized quality measurement.
- Current limitations in standardized quality metrics hinder the application of these models.
Conclusions:
- Healthcare payment structures significantly shape healthcare organization and management.
- Improved measurement, realistic targets, and focus on practice redesign are needed.
- Payment reform is essential for accurately assessing practice transformation and its impact on patient and societal outcomes.
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