All healthcare stakeholders are on the same page when it comes to using value-based payments, two leaders from Cigna said yesterday at the National Bundled Payment Summit in the District of Columbia. But insurers can't have only one type of value-based program.
Providers have different capabilities, ownership and risk tolerance, so payers must meet doctors where they are organizationally, according to Jeannie Hubbell, director of payment innovation for Cigna Healthcare in Franklin, Tennessee.
Cigna has been using Tennessee as a Petri dish to develop payment models that reward value, said Jim Humphrey, Cigna's operations director in Nashville, Tennessee. One approach was bundled payments for episodes of care for deliveries, hip replacements and knee replacements.
That model involved collaboration with other payers and providers. For instance, technical advisory groups (TAG), comprised of providers, other stakeholders and constituents across the state, helped develop episode definitions and metrics. Thanks to the provider input, the metrics are universally accepted by provider groups in Tennessee, Humphrey said.
Humphrey and Hubbell also emphasized that cost is very important to the bundled payment model. Cigna has to show the value of the episodes back to the client, so it looks at episodes that will have the biggest impact for the client as well as the most operational scale.
To demonstrate value, Cigna focuses on actionable reporting. It gives information to physician practices that can lead to changes in practice patterns. "If you can be transparent and show the practice where they need to go with that information, the results will come with that particular episode program," Humphrey said.
Cigna also aims to measure bundled payment success with claim-based metrics. However, Hubbell and Humphrey said quality metrics need to expand beyond claims to include patient satisfaction, potentially avoidable complication rates and functional status.
"As we implement different reimbursement structures, performance measurements need to evolve," Hubbell said. The industry needs to get away from discount comparisons and look at improvements in quality.