8 ways to standardize reimbursement

Changing the American healthcare system is going to take physician buy-in, but that's not going to happen without getting all the payers on the same page, says a new report by Milbank Memorial Fund.

Primary care physicians are especially important, the study found, for driving healthcare reform, but they are often the most hesitant to embrace the transitions laid out in the Affordable Care Act, write the report's authors. 

"Since most primary care practices are reimbursed from a mix of commercial health plans and public programs (like Medicare and Medicaid) that differ across health care markets, practices resist full-scale transformation when payers are not in alignment," the report says.

Making the leap to payer alignment is easier said than done, however, but some states have taken on the challenge. The report was based on a survey of the Multi-State Collaborative (MC), an effort supported by the Milibank Memorial Fund. The MC includes a voluntary group of stakeholders from state-based, multi-payer primary care transformation initiatives who regularly collaborate with payers.

The study found that among the groups that made inroads in payer alignment, eight common elements were present. These were:

  • Innovative payment reforms to support primary care
  • Multiple payer participation
  • State government convening role
  • Standards for primary care medical home identification
  • New staffing models for team-based primary care
  • Technical assistance to practice sites
  • Common measurement of performance
  • Collaborative learning

"The lessons learned here have implications not only for primary care transformation, but also for state-convened provider payment reform initiatives and any effort at health care transformation requiring alignment across multiple payers," authors of the study say.

For more:
- here's the study