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Healthcare Payment Models

Creative healthcare finance and making use of alternative payment models can lead to innovative healthcare payment solutions that drive value. How does your organization's revenue model stack up?

Three-Part Pricing of PCSK9 Inhibitors

New Marketplace

A New Model for Pricing Drugs of Uncertain Efficacy

Are we paying too much for new drugs before we know how well they work? This innovative pricing model proposes postponing major rewards until efficacy is established — which could help both patients and payers while still paying back investments on the most effective drugs.

A Prescription for the Ailing U.S. Health Care Market - Leemore Dafny talk still

New Marketplace

Prescription for an Ailing U.S. Health Care Market

Three components for treating the unhealthy, uncompetitive U.S. health care market — beginning with a buyer’s revolt.

Cautious Optimism That Value-Based Reimbursement Will Become Primary Revenue Model

New Marketplace

Survey Snapshot: What Would Accelerate the Adoption of Value-Based Care?

NEJM Catalyst Insights Council members weigh in on the barriers and path forward to value-based health care.

Fee-for-Service Continues to Account for the Majority of Revenue

New Marketplace

New Marketplace Survey: Transitioning Payment Models: Fee-for-Service to Value-Based Care

In a survey of the NEJM Catalyst Insights Council sponsored by Optum, respondents express enthusiasm for value-based care but have conflicting opinions about just how far along that path they should go.

Comparison Between Traditional and Proposed Health Reimbursement Plan for Primary Care Outcomes Model Across Five Key Domains

New Marketplace

Payment Designed for People: Introducing the Primary Care Outcomes Model

A care and payment model that engages primary care physicians in an aligned model built on trust and value could result in better patient care at lower costs.

Figure 1. Differential Changes in Total Medicare Spending for Patients in Accountable Care Organizations (ACOs), According to the Type of ACO, Year of Entry, and Number of Years of Participation.

New Marketplace

Medicare Spending after 3 Years of the Medicare Shared Savings Program

After 3 years of the MSSP, participation in shared-savings contracts by physician groups was associated with savings for Medicare that grew over the study period, whereas hospital-integrated ACOs did not produce savings (on average) during the same period.

Mechanic02_pullquote self-insured employers

New Marketplace

Self-Insured Employers — The Payment-Reform Wild Card

Without more private-sector leadership, U.S. health care will remain stuck in a fee-for-service system for the foreseeable future.

Washington State Health Care Authority Center of Excellence joint replacement elements and outcomes of program produces strong patient experience scores

New Marketplace

Improving Care by Redesigning Payment

A state-run center of excellence uses benefit design to improve outcomes while controlling cost.

Alaigh03_pullquote aco and bundled payment co-exist

New Marketplace

ACOs and Bundled Payments: How the Two Can and Should Coexist

The integration of primary care and specialty care physicians through adoption of both payment models will lead to synergistic value.

Pham03_pullquote payment and delivery-system reform

New Marketplace

Payment and Delivery-System Reform — The Next Phase

To truly redesign a system, one has to take a holistic approach and move multiple levers in concert, rather than fiddling with individual factors serially and hoping for a coordinated effect.

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