Medical home a model for multi-payer reform initiatives

Multi-payer payment reform faces a host of legal, logistical and even political obstacles, but a group of experts with the National Academy for State Health Policy (NASHP) say the medical home model can provide a blueprint for further efforts, such as bundled payments and the accountable care organization (ACO).

The NASHP studied the 17 multi-payer medical home initiatives started in the United States between 2008 and 2014 and identified the following four challenges that the medical home model faces and that apply to all multi-payer initiatives. The study will be published in the April 2015 edition of Health Affairs; FierceHealthPayer received an advanced copy of the report.

Convene stakeholders. State entities led the medical home initiatives in 12 of the 17 states. Their involvement offers several advantages, chief among them antitrust protection, the study said. State entities can also mandate that payers participate, though this becomes unnecessary as payers pursue the medical home, ACO or bundled payment model on their own.

Establish criteria for provider participation. Use applicable standards, modifying them to fit your needs. In this case, the study said, the bulk of the medical home models turned to National Committee for Quality Assurance, the Joint Commission, the Accreditation Association for Ambulatory Health Care and/or the Utilization Review Accreditation Commission.

Determine payment. All 17 medical home initiatives built on existing fee-for-service payment arrangements. This reflects the notion that changing too much too quickly can discourage providers from participating, especially when the new payment model pertains to a small percentage of the business, the study said. In addition, only one of the 17 medical home models required providers to take on downside risk. Finally, standardized reimbursement has given way to more flexible reimbursement models in the medical home initiatives.

Measure performance. Use a variety of survey, claims and clinical data, the study recommended. Bear in mind that clinical quality measures often measure what's easiest to assess since they place such an administrative burden on many practices, FierceHealthcare previously reported. The wide range of metrics helps provide a broad picture of an initiatives' ability to affect overall health goals.

Going forward, the study concluded, Medicare partnerships "will be integral to future health system transformation" as well as multi-payer reform efforts.

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