Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness: Proceedings of a Workshop by unknow

Author:unknow
Language: eng
Format: epub
Tags: Health and Medicine: Healthcare and Quality, Health and Medicine: Policy, Reviews and Evaluations
Publisher: The National Academies Press
Published: 2018-05-16T00:00:00+00:00

Discussion

After the second session’s presentations on financing and payment innovations, Paz opened the discussion by asking the panel what they would describe as the key outcome measures needed to define the quality of the serious illness programs and align that care with value-based reimbursement. Fine explained that because Baylor focuses on patient care planning, creating new advance directives, getting the appropriate changes and code statuses, decreasing the number of attempted, non-beneficial CPRs, and tracking symptom outcomes are very important, despite the variability across hospital campuses. Popiel then added that beyond those metrics, the alignment of the experience of the patients, their caregivers, and their families is also important. However, he noted, the quality of that experience is hard to quantify beyond a typical satisfaction score.

Teresa Lee of VNA Health Group pointed out that her organization is still learning lessons from their participation in the Medicare Care Choices Model and CPC Plus. She noted that although CPC Plus was not originally intended for home care medicine, clinicians are able to innovate because they “have the funds up front [and are able] to make investments” in innovative practices and quality measures. In working with the Medicare Care Choices Model, Lee noted that the program’s largest challenge was that payment was not sufficient to provide hospice and all curative treatments comprehensively.

Allison Silvers from the Center to Advance Palliative Care explained that her organization is working to ensure sufficient compensation for the time providers need to attend to the seriously ill. Silvers asked the panel whether there is additional work to be done in terms of investing in bringing the health system up to speed, enhancing the skills that providers need, and whether payers would pay for that training. Popiel responded that Cambia’s work is only beginning to scratch the surface “in terms of education and support” for network providers, regardless of whether they are in a “value-based payment arrangement or [a] broader PPO [preferred provider organization] network.” He believes there is more to be done, and that the next steps should involve more intensive collaboration and training. Debono agreed, explaining that Anthem “envision[s] a situation in which [the clinicians, staff, and practice] are participating in some sort of value-based payment model and the payer participates in training the practice.” Chirico posited that “that methodology [may not] be any better with an insurance-backed concept of education because of the expertise.” Ling responded, “practices are learning to redesign themselves” and that the Transforming Clinical Practice Initiative,23 as an example, is helping to understand the costs and to inform the services that need to be delivered.

Becky Shipp of the Sheridan Group wondered from the “view [of] the field, are these programs working?” To give context, she explained that there are many state-based programs, but many are not available in every state. Dr. Ling explained that the programs have provided access to services, but that the challenge is to determine consistent measures, such as quality, in order to evaluate these programs in a rigorous fashion. She then

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