Alternative Payment Models

Submitted by hci3-usr on Saturday, February 6, 2016 - 04:41

Newtown, CT – February 6, 2016

The press releases are about done and will be unleashed in rapid succession, and here’s why – We’ve known for several years that building scalable operational and analytical solutions to support alternative payment models was the only way to ensure their lasting success. After all, the math is simple and the outcomes are all but certain. If you hold hospitals and physicians at risk for costs in excess of a budget, after appropriately adjusting for the severity of patients, and you hold the line on fee schedule increases, costs of care will, at worst, flatten, and, at best, go down. Once the certainty has come to pass, the pressure to expand the reach and breadth of APMs becomes significant, as it has, and payers and providers must respond. Some of our early pilot partners, Horizon Blue Cross Blue Shield and Blue Cross Blue Shield of North Carolina in particular, had the foresight to plan ahead and made it clear to their vendors that they had to build operational solutions that would help them expand their new payment programs. Similarly, providers who found themselves in the throws of supply chain management, practice redesign, and process improvement, realized that the basic reporting and analytic tools available to them were of little use. So for the past five years we have been working with our pilot partners to learn what works and what doesn’t, and to support established companies and start-ups develop solutions that can help payers scale out the implementation of APMs, and help providers hone in on the process improvements that will pay off best. And now they’re finally ready for prime time.

What this means to you – During the balance of this year we will be publishing three implementation case studies that show how APMs can succeed for payers, providers and, most importantly, for patients. Horizon’s results are impressive and leave little doubt about the effectiveness of their bundled payment program. Their case study will come out next week. Helping them to fully scale their operational solution is TriZetto, and what they have accomplished can be a watershed moment in the country’s transition to innovative payment models. Younger companies like Aver and HealthQx can provide deep analytic insights to payers and providers, while also supporting both in bundled payment implementations. When we first launched the PROMETHEUS Payment model with the generous support of the Robert Wood Johnson Foundation, academics scoffed and others passed it off as another futile attempt to change the market. But the math was simple and self-evident, and the transformation of providers exhilarating, which is why we forged ahead. Today, that effort is the basis for these scalable and fully operational solutions, and they’re coming on-line just when the country needs it most. So watch for these press releases and pay attention, because the agents of the status quo will continue to claim that scaled implementations are too complicated, that they don’t have the tools, and that the math isn’t clear. They were wrong then, and they’re even more so now.

Francois Sig
Francois de Brantes
Executive Director