Transparency on quality, outcomes key to personalized care

A report by the Brookings Institution says that more integrated care systems and a shift away from fee-for-service payment models could deliver more personalized care and could save $300 billion over a decade, and as much as $1 trillion over two decades.

More than a dozen health and economic experts were involved in writing the report, called "Bending the Curve," which outlines proposed reforms to Medicare, Medicaid and private insurance.

Technology, according to the authors, plays an integral role in such efforts.

"As a result of fundamental breakthroughs in biomedical science, improvements in data systems and network capabilities, and continuing innovation in healthcare delivery, care is becoming increasingly individualized and prevention-oriented," the authors state in an announcement accompanying the report. "The best treatment for a patient involves not just specific services covered under traditional approaches to health insurance financing, but also includes new technologies and new kinds of care and support at home and beyond traditional health care settings."

The authors added that through the use of technology, providers and patients could avoid a fee-for-service model, and instead receive more support for specific approaches to care delivery that make the most difference

The plan's recommendations included:

  • Promoting standard methods for quality reporting, including clinical, outcome, and patient-level.
  • Promoting standard methods for timely data sharing among plans, providers and patients.
  • Providing further support for state investments to update their Medicaid information systems, including standard quality measure reporting and access to CMS data for quality improvement.
  • Removing barriers to telemedicine services caused by state-specific licensing restrictions to enable licensing reciprocity.

The authors proposed phasing out fee-for-service payment in Medicare over 10 years, to be replaced by comprehensive payment organizations that must meet set quality and outcome requirements for full payment.

The ideas for improved care quality and cost containment already have bipartisan support, according to the authors. Acting Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner recently said she opposes an arbitrary target date for ending fee-for-service payment, instead calling for an "incremental, aggressive strategy."

Recent healthcare policy changes already are driving payers and providers closer together, Patrick Pilch, managing director of BDO Consulting, wrote in a guest commentary published in FierceHealthFinance last week.

A recent study in the Journal of the American Medical Association, however, found that insurers could save a lot of money through better incentives for hospitals to reduce surgical errors. Researchers found that private insurers pay hospitals an average of $39,000 more for patients with surgery complications, compared to the $1,700 additional medical claims for Medicare.

To learn more:
- find the report (.pdf)
- here's the announcement


Fuel Top Line Growth and Increase Membership

In this webinar, payers can learn how to accelerate the sales pipeline and grow membership across all health insurance market segments using comprehensive sales technologies.