Payment Incentives and Integrated Care Delivery: Levers for Health System Reform and Cost Containment

First Published December 1, 2011 Research Article Find in PubMed

The Patient Protection and Affordable Care Act encourages use of payment methods and incentives to promote integrated care delivery models including patient-centered medical homes, accountable care organizations, and primary care and behavioral health integration. These models rely on interdisciplinary provider teams to coordinate patient care; health information and other technologies to assure, monitor, and assess quality; and payment and financial incentives such as bundling, pay-for-performance, and gain-sharing to encourage value-based health care. In this paper, we review evidence about integrated care delivery, payment methods, and financial incentives to improve value in health care purchasing, and address how these approaches can be used to advance health system change.

Abraham, J. M., Feldman, R., Carlin, C., Christianson, J. 2006. The Effect of Quality Information on Consumer Health Plan Switching: Evidence from the Buyers Health Care Action Group. Journal of Health Economics 25 (4): 762781.
Google Scholar | Crossref | Medline | ISI
Berenson, R. 2010. Shared Savings Program for Accountable Care Organizations: A Bridge to Nowhere? American Journal of Managed Care 16 (10): 721726. http://www.ajmc.com/issue/managed-care/2010/2010-10-vol16-n10/AJMC_10oct_Berenson_721to726. Accessed December 13, 2010.
Google Scholar | Medline | ISI
Black, A. D., Car, J., Pagliari, C. 2011. The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLoS Medicine 8 (1): 116.
Google Scholar | Crossref | ISI
Buchmueller, T. C. 2009. Consumer-Oriented Health Care Reform Strategies: A Review of the Evidence on Managed Competition and Consumer-Directed Health Insurance. Milbank Quarterly 87 (4): 820841.
Google Scholar | Crossref | Medline | ISI
Butler, M., Kane, R. L., McAlpine, D. 2008. Integration of Mental Health/Substance Abuse and Primary Care. Evidence Reports/Technology Assessments, No. 173. Rockville, Md.: Agency for Healthcare Research and Quality.
Google Scholar
Casale, A., Paulus, R. A., Selna, M. J., Doll, M. C., Bothe, A. E., McKinley, K. E., Berry, S. A., Davis, D. E., Gilfillan, R. J., Hamory, B. H., Steele, G. D. 2007. ProvenCareSM: A Provider-Driven Pay-for-Performance Program for Acute Episodic Cardiac Surgical Care. Annals of Surgery 246 (4): 613621.
Google Scholar | Crossref | Medline | ISI
Christianson, J. B., Feldman, R. 2005. Exporting the Buyers Health Care Action Group Purchasing Model: Lessons from Other Communities. Milbank Quarterly 83 (1): 149176.
Google Scholar | Crossref | Medline | ISI
Christianson, J. B., Feldman, R., Weiner, J. P., Drury, P. 1999. Early Experience with a New Model of Employer Group Purchasing In Minnesota. Health Affairs 18 (6): 100114.
Google Scholar | Crossref | ISI
Collins, C., Hewson, D. L., Munger, R., Wade, T. 2010. Evolving Models of Behavioral Health Integration in Primary Care. New York: Milbank Memorial Fund.
Google Scholar | Crossref
Darves, B. 2007. Physician Pay for Performance Programs Taking Hold. New England Journal of Medicine Career Center, December. http://www.nejmjobs.org/career-resources/pay-for-performance.aspx. Accessed October 13, 2010.
Google Scholar
Fields, D., Leshen, E., Patel, K. 2010. Driving Quality Gains and Cost Savings through Adoption of Medical Homes. Health Affairs 29 (5): 819826.
Google Scholar | Crossref | ISI
Grumbach, K., Grundy, P. 2010. Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the United States. Patient-Centered Primary Care Collaborative (updated November 16, 2010). http://www.pcpcc.net/content/pcmh-outcome-evidence-quality. Accessed December 13, 2010.
Google Scholar
Guterman, S., Blake, H. 2010. Developing Innovative Payment Approaches: Finding the Path to High Performance. May. New York: The Commonwealth Fund. http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2010/Jun/Developing-Innovative-Payment-Approaches.aspx. Accessed December 13, 2010.
Google Scholar
Hahn, J. 2006. Pay for Performance in Health Care. November 2. Washington, D.C.: Congressional Budget Office. http://www.allhealth.org/briefingmaterials/CRSReportingforCongress-Pay-for-PerformanceinHealthCare-501.pdf. Accessed March 8, 2011.
Google Scholar
Institute of Medicine Board on Health Care Services . 2006. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, D.C.: The National Academies Press.
Google Scholar
Jain, S., Roble, D. 2008. Gainsharing in Health Care: Meeting the Quality-of-Care Challenge. Healthcare Financial Management March 8:7278.
Google Scholar | Medline
Ketcham, J. D., Furukawa, M. F. 2008. Hospital-Physician Gainsharing in Cardiology. Health Affairs 27 (3): 803812.
Google Scholar | Crossref | ISI
Kolstad, J. T., Chernew, M. E. 2009. Quality and Consumer Decision Making in the Market for Health Insurance and Health Care Services. Medical Care Research and Review 66 (1 suppl): 28s52s.
Google Scholar | SAGE Journals | ISI
Lyles, A., Weiner, J. P., Shore, A. D. 2002. Cost and Quality Trends in Direct Contracting Arrangements. Health Affairs 21 (1): 89102.
Google Scholar | Crossref | ISI
Mathematica Policy Research, Inc . 2009. Summary: Global Payment. http://www.mass.gov/Eeohhs2/docs/dhcfp/pc/2009_02_13_Global_Payment-C2.pdf. Accessed November 13, 2010.
Google Scholar
McClellan, M. 2009. Reforming Provider Payment: Moving Toward Accountability for Quality and Value. Senate Finance Committee, Roundtable on Health Care Reform, April 21, 2009.
Google Scholar
McClellan, M. 2011. Reforming Payments to Healthcare Providers: The Key to Slowing Healthcare Cost Growth While Improving Quality? Journal of Economic Perspectives 25 (2): 6992.
Google Scholar | Crossref | Medline | ISI
McClellan, M., McKethan, A. N., Lewis, J. L. 2010. A National Strategy to Put Accountable Care into Practice. Health Affairs 29 (5): 982990. http://content.healthaffairs.org/content/29/5/982.full. Accessed January 2, 2011.
Google Scholar | Crossref | ISI
Mechanic, R. E., Altman, S. H. 2009. Payment Reform Options: Episode Payment Is a Good Place to Start. Health Affairs Web Exclusive January 27. 28 (1, suppl): w262271. http://content.healthaffairs.org/cgi/content/abstract/28/2/w262. Accessed November 27, 2010.
Google Scholar | Crossref | ISI
Medicare Payment Advisory Commission (MedPAC) . 2005. Report to the Congress: Medicare Payment Policy. March. http://www.medpac.gov/publications/congressional_reports/Mar05_EntireReport.pdf. Accessed December 13, 2010.
Google Scholar
Medicare Payment Advisory Commission (MedPAC) . 2008. Report to the Congress: Reforming the Delivery System. June. http://www.medpac.gov/documents/jun08_entirereport.pdf. Accessed July 23, 2010.
Google Scholar
Medicare Payment Advisory Commission (MedPAC) . 2010. Comments to Donald Berwick, administrator of Centers for Medicare and Medicaid Services (CMS). CMS Request for Information Regarding Accountable Care Organizations and the Medicare Shared Savings Program. Federal Register 75 (221): 7016570166. http://www.medpac.gov/documents/11222010_ACO_COMMENT_MedPAC.pdf. Accessed December 22, 2010.
Google Scholar
Network for Regional Healthcare Improvement . 2009. Better Ways to Pay for Health Care: A Primer on Healthcare Payment Reform. November 14. http://www.rwjf.org/healthreform/product.jsp?id=37448. Accessed January 23, 2010.
Google Scholar
Nichols, L. M., O'Malley, A. S. 2006. Hospital Payment Systems: Will Payers Like the Future Better Than The Past? Health Affairs 25 (1): 8193.
Google Scholar | Crossref | ISI
Patient Choice Health Care website. http://www.patientchoicehealthcare.com/aboutus/index.html. Accessed December 27, 2010.
Google Scholar
Reid, R. J., Coleman, K., Johnson, E. A. 2010. The Group Health Medical Home at Year Two: Cost Savings, Higher Patient Satisfaction, and Less Burnout for Providers. Health Affairs 29 (5): 835843.
Google Scholar | Crossref | Medline | ISI
The Robert Wood Johnson Foundation . 2009. Spotlight on Payment Reform. September 23. http://www.rwjf.org/pr/product.jsp?id=48828. Accessed December 12, 2009.
Google Scholar
Rosenthal, M., Frank, R. G. 2006. What Is the Empirical Basis for Paying for Quality in Health Care? Medical Care Research Review 63: 135.
Google Scholar | SAGE Journals | ISI
U.S. Government Accountability Office (U.S. GAO) . 2008. Medicare Physician Payment: Care Coordination Programs Used in Demonstration Show Promise, But Wider Use of Payment Approach May Be Limited. GAO-08-65. Washington, D.C.: GAO.
Google Scholar
Werner, R. M., Dudley, R. A. 2009. Making the “Pay” Matter in Pay-for-Performance: Implications for Payment Strategies. Health Affairs 28 (5): 14981508. WPS Insurance website. http://www.wpsic.com/insurance/group-insurance-patient-choice.shtml. Accessed December 28, 2010.
Google Scholar | Crossref | ISI

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