A framework for making an effective and orderly transition to
global payment was the main topic at today's next-to-last meeting
of the Special Commission on the Health Care Payment System.
The commission's transition framework relies heavily on the
creation of Accountable Care Organizations (ACOs), virtual or
actual provider networks that integrate health care services and
improve coordination of patient care.
The structure, scope, and function of ACOs was one of many
parameters that an independent board to oversee the transition
would be charged with, according to the framework. The board would
also be responsible for identifying adjustment factors for global
payments and tracking milestones, among other tasks. The framework
calls for board intervention if certain milestones are not met,
which sparked debate about state rate setting and the
stick-or-carrot approach to incentives. Commission member Alice
Coombs, M.D., MMS president-elect, called for a "nurturing"
approach to help providers make the change rather than
penalty-based incentives.
The timeframe set forth in the framework for a completed
transition to global payment is five years or less, and it
encourages providers who are in a higher state of readiness to move
more quickly.
There was also debate about the so-called "complementary
strategies" that many stakeholders say must be addressed in tandem
with payment reform. These include malpractice reform, health plan
benefit redesign, and administrative simplification. Some
commission members, including Dr. Coombs, insisted that these
strategies are inextricably linked to payment reform, while other
commission members said such matters could distract the board from
its primary purpose.
The commission's final meeting, originally scheduled for May 26,
has been postponed until late June. Between now and then, the
commission will iteratively draft a final report of recommendations
for the Legislature.
