3 recommendations for HHS payment reform

As part of its shift from fee-for-service to the value-based payment model, the Department of Health and Human Services should focus on bundled payments, cancer treatment and improving the accountable care organization (ACO) model. argues a new opinion piece by healthcare economist Ezekiel Emanuel and colleagues for the Center for American Progress (CAP).

HHS' official target--50 percent of fee-for-service Medicare payments made through alternative payment models by 2018—is a commendable starting point, write Emanuel, a senior fellow at CAP, and his coauthors, Allyson Y. Schwartz, Topher Spiro, Topher Spiro, who all work CAP. From this stage, the piece states, HHS must outline the specific processes it plans to achieve this goal, which will signal confidence in its course to both payers and healthcare providers.

The authors recommond HHS take several steps, including:  

Expand bundled payments:  Slower healthcare spending indicates cost-control expectations already affect providers, the piece states, but policymakers must make concrete reforms to preserve their momentum. President Barack Obama's administration must expand at least one payment reform to the entire country before Obama leaves office, the piece states and Medicare's Acute Care Episode program, under which discounted, bundled payments would replace fee-for-service payments are the ideal candidate. The authors recommend the government start with orthopedic bundles or begin the rollout in the South and Southeast, where Medicare per-beneficiary spending is already highest and the model has already demonstrated results.

Reform cancer treatment payments: CAP has high hopes for bundling payments for cancer treatments, which are some of the most expensive under the fee-for-service model. A panel assembled by CAP has identified cancers better suited to the bundling model, definitions of episodes of care, quality metrics and definitions of episodes of care, according to the piece.

Learn from ACOs: ACOs' are a central plank of alternative payment models, but thus far have shown mixed results. While only 11 of the 23 ACOs participating in the Pioneer program its second year earned shared savings, there is still potential for larger savings, the piece states. "[I]t will take time for all Pioneers to achieve significant savings given the need to invest in infrastructure, restructure their delivery of care, and adapt to changed payment incentives," they write. "Pioneers that are not achieving savings should learn from and adopt the best practices of their peers that have been more successful."

To learn more:
- here's the opinion piece