The nine members of the state Payment Reform Commission spent
most of their third public meeting today learning about more two
alternative physician and hospital payment models.
But for many observers (including the MMS), there was more
interest in the commission's brief update on its draft operating
principles.
The first round of draft principles were unveiled a month ago at
the commission's first meeting, and were fairly well picked apart
by members and other attendees. Since then, the commission has been
systematically collecting feedback from hospital officials,
physicians and consumer advocates. (Business leaders are next
week.)
Commission consultant Michael Bailit quickly ran through seven
new concepts that the commission heard at these feedback sessions.
He didn't offer any opinions on these concepts, but said they
should be considered by the commission in its discussions.
The seven concepts are:
- No single payment model will work for all providers
- Payment reform should address the shortage of primary care
physicians
- Payment reform should address the balance of payments between
interventional and non-interventional care. (No further explanation
was offered.)
- The commission should continue to evaluate payment models and
identify unintended consequences from changes in payment
methodology
- Payment methodologies should be transparent to all, including
patients
- Payment reform needs to have interaction between payment models
and health care delivery systems. (No further explanation was
offered.)
- Risk adjustments should include consideration of patient
socioeconomic status, as well as for health status.
Bailit said there would be discussion of the principles at the
commission's next meeting on Feb. 24.
The commission then heard detailed presentations about two kinds
of payment models: medical homes and pay for performance.
There was a shorter conversation about the idea of aligning
payment models with benefit design - namely, consumer-directed
networks and tiered networks. Commission member Dolores Mitchell,
head of the Group Insurance Commission, quietly left the meeting
before this part of the discussion. (The MMS has sued the GIC and
two health plans to "correct the wrongs" of the GIC's physician
tiering program.)
On Feb. 24, the commission is also expected to get presentations
on two more payment models, episode-of-care payments and
evidence-based purchasing.
The MMS has posted a suggested reading list on payment
methodologies, as well as links to white papers distributed by the
commission at today's meeting.
