The DRG Mismatch

Is it chest pain or something else? Is it an AMI or CABG or both?…

June 27, 2014

Key Payer and Provider Operational Steps for Successfully Implementing Bundled Payment

This is the third in a series of annual issue briefs that have tracked the development and implementation of bundled payments in the public and private sectors.  This brief builds upon the two previous issue briefs  by providing a more…

May 28, 2014

Report Card on State Price Transparency Laws – 2014

March 25, 2014

Dear Colleagues, When we released our inaugural Report Card on State Price Transparency Laws in 2013, it was the first time policy makers, consumer advocates, and other health care leaders had a comprehensive resource showing how readily consumers could find…

March 24, 2014

Attending Orthopedic Surgeons Estimates Of Device Costs, By Device Cost.

How well do orthopedic surgeons estimate the costs of joint implants? from Health Affairs 2014; 33:103-109…

January 14, 2014

State Report Card on Transparency of Physician Quality Information

HCI3 Improving Incentives Report - December 2013

Introduction In its seminal publications on the Quality of Health Care in America, the Institute of Medicine called for the measurement and reporting of physician quality. That was in 1999 and 2000. Since then much work has been done in…

December 6, 2013

Reference Pricing and Bundled Payments

A Match to Change Markets

As the costs of health care continue to increase, employers are turning to innovations in health care payment, benefit design, and network design to manage their costs. One reform that has gotten recent attention is reference pricing. Yet when used…

November 14, 2013

Legal Issues in Designing Bundled Payments and Shared Savings Arrangements in the Commercial Payor Context

A promising method for restructuring the health care payment system involves packaging payments for multiple, related services into a “bundle” to pay for a single episode of care. For example, a bundled payment for a hip replacement surgery would include…

September 10, 2013

Improving Incentives to Free Motivation

“Improving Incentives to Free Motivation,” calls for an approach to payment reform that harnesses the inherent motivation that doctors and patients have to make good decisions about health care. The authors reject the assumption that health care costs will drop…

August 7, 2013

Model State Health Care Price and Quality Transparency Legislation

In March 2013, the Health Care Incentives Improvement Institute and Catalyst for Payment Reform issued a report card ranking each state in the US on the availability and accessibility of health care services pricing. In December 2013, another report card…

July 25, 2013

Bundled Payments One Year Later

An Update on the Status of Implementations and Operational Findings—May 30, 2013

Foreword Form drives function and incentives drive function. That's the basic principle that is driving so many to focus on moving away from fee for service to alternative payment models. In March, Catalyst for Payment Reform issued a scorecard showing…

June 10, 2013

Of Regional Cost Variation

Chronic Conditions: PAC Costs Drive Total Cost Variation

Of Regional Cost Variation is a set of two slides showing how potentially avoidable complication (PAC) costs drive total cost variation in chronic conditions as well the variation in PAC rates across states.…

May 31, 2013

Rhode Island – Health Insurance Bulletin 2013-1

Health Care Price Transparency

(a) Purpose. This Bulletin is issued by the Office of the Health Insurance Commissioner [of Rhode Island] for the purpose of communicating to health insurance issuers the Commissioner’s interpretation of their obligations under state laws and regulations to disclose to…

May 23, 2013

Of Price, PACs, and Patients

Understanding Sources of Variation in Healthcare Costs

These slides (PDF format) allow you to explore and understand sources of variation in healthcare costs using graphs and charts based on empirical data.…

May 23, 2013

Designing Incentives to Improve Care: Tools from the Leapfrog Group

The Leapfrog Group is a coalition of many of the nation's largest corporations and public agencies founded by The Business Roundtable, a national association of Fortune 500 CEOs, to address patient safety and quality issues in the American health care…

March 22, 2013

Physician Pay-for-Performance in Medicaid: A Guide for States

Medicaid, one of the largest health care purchasers in the country, can play a leading role in testing the viability of physician-level pay-for-performance (P4P) strategies to improve health care quality for low-income, racially diverse, and chronically ill individuals. Physician Pay-for-Performance…

March 22, 2013

Wellness Incentives, Equity, and the Five Groups Problem

The study's author, 2009–10 Commonwealth Fund Harkness Fellow Harald Schmidt, characterized employees as belonging to one of five groups: "the lucky ones," whose behavior is effortlessly compatible with wellness goals; "the yes-I-can" group, who welcome the opportunity to join an…

March 22, 2013

Shared-Savings Payment Arrangements in Health Care: Six Case Studies

Driven by widespread interest in improving health care quality and reducing costs and by the Affordable Care Act’s “accountable care” provisions, shared-savings programs are gaining traction as an alternative approach to paying health care providers. Providers receive a share of…

March 22, 2013

Aligning Incentives in Medicaid: How Colorado, Minnesota, and Vermont Are Reforming Care Delivery and Payment to Improve Health and Lower Costs

Colorado, Minnesota, and Vermont are pioneering innovative health care payment and delivery system reforms. While the states are pursuing different models, all three are working to align incentives between health care payers and providers to better coordinate care, enhance prevention…

March 22, 2013

Ethical Physician Incentives – – From Carrots and Sticks to Shared Purpose

For ACOs to be successful, they must improve the efficiency of care, meet patients’ expectations for care and clinical outcomes, and attract and retain top-quality professionals. Incentives like pay-for-performance bonuses are key management tools for achieving these goals. Taken alone,…

March 22, 2013

Payments in Support of Effective Primary Care for Chronic Conditions

The researchers used Capital District Physicians’ Health Plan, a nonprofit network-model HMO in New York, as a test case. In January 2009, the plan launched a pilot program in three primary care practices where providers received bundled payments, adjusted to…

March 22, 2013

At Pitney Bowes, Value-Based Insurance Design Cut Copayments and Increased Drug Adherence

By eliminating or reducing copayments for key drugs prescribed for employees at risk for cardiovascular disease, a value-based health insurance program at the U.S.-based firm Pitney Bowes led to modest increases in medication adherence rates compared with a control group.…

March 22, 2013

Full Coverage for Preventive Medications After Myocardial Infarction

Heart attack patients discharged from the hospital were more likely to take prescription medications for their condition when copayments were eliminated, compared with patients who had copayments. Patients who had their copayments waived also experienced fewer heart attacks, strokes, and…

March 22, 2013

Full Coverage for Preventive Medications After Myocardial Infarction

Heart attack patients discharged from the hospital were more likely to take prescription medications for their condition when copayments were eliminated, compared with patients who had copayments. Patients who had their copayments waived also experienced fewer heart attacks, strokes, and…

March 22, 2013

The Impact of Reducing Cardiovascular Medication Copayments on Health Spending and Resource Utilization

Insurers impose copayments to reduce overall health care spending, but these higher out-of-pocket expenses can also prompt patients to reduce their use of essential medications. Previous studies have shown that reducing or eliminating copayments for cardiovascular medications prescribed after heart…

March 22, 2013

A Hospital System’s Wellness Program Linked to Health Plan Enrollment Cut Hospitalizations but Not Overall Costs

Employers are increasingly looking to wellness programs to encourge healthy behaviors among their employees and control health care spending. A study examining the effects of a wellness program on workers’ health service use found a substantial decrease in hospitalizations for…

March 22, 2013