Study: Chronic disease payment needs changes

While most providers agree that most compensation arrangements don't work well for treating chronically-ill patients, payers have done little to change how they reimburse doctors and hospitals for chronic care, according to a new study by the Center for Studying Health System Change. Existing payment systems encourage disconnected forms of delivery, rather than coordinated care, according to Center President Paul Ginsburg, PhD. 

The study describes several pilot programs offering financial incentives for providers caring for chronically ill patients. These include a 2005 diabetes management program by BCBS of North Dakota that uses a nurse case manager to better coordinate care planning and patient self-management. Also included is Rhode Island Medicaid's primary care case management program for adults with multiple chronic conditions enrolled in its fee-for-service program. It also describes the new risk-adjusted annual global payment now being offered by BCBS of Massachusetts.

Barriers to developing more-effective chronic care payment systems include a fragmented care delivery system, lack of payment for nonphysician providers and lack of champions for payment reform, according to the Center's recent report.

To learn more about the study:
- read this HFMA News piece
- read the Center for Studying Health System Change report

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