New Marketplace
Clip
Much Ado About Nothing Over Payment Reform? (05:00)

In their talks during the NEJM Catalyst event “Navigating Payment Reform for Providers, Payers, and Pharma,” both Michael McWilliams and Griffin Myers state that a certain amount of necessary payment reform might just happen on its own if we let things play out.

“Is our concern with payment reform maybe a bit of a much ado about nothing?” asks Robert Huckman during the event’s second panel discussion. “Should we let the system play its course? Or do we need to just give maybe more subtle nudges than we’re doing?”

“I believe that we’re doing too much in payment reform,” answers McWilliams. “There are too many horses out there, and we can’t have a horse race because they’re all knocking into each other.” He references the debate over bundling versus global payment as an example.

“We need to be careful about what we mean by payment reform and let a model run its course for a while to see where that takes us,” he says. “I tend to think that the global budget model, with a primary care–based risk-bearing entity, is the horse to ride and see where it takes us for a while.”

That said, the presence of disturbing trends like rapid consolidation — will any independent, risk-bearing primary care groups be left? — means that the system could use some help. “Getting the market structure right so that these payment models can really work as they should, that’s the key,” says McWilliams. He suggests the implementation of complementary policies, along with site-neutral payments and/or reforming the 340B Drug Discount Program — and reforming financial incentives that underlie the impetus for consolidation.

Myers answers Huckman’s questions from a different perspective — as someone who builds care teams rather than recommends policies. “You can’t expect policymakers to create policies for groups like Oak Street Health,” he says. “There are 60 million Medicare-eligibles; we take care of 30,000-something folks.” According to Myers, no public policy change of the past 20 years has affected Oak Street Health, with the exception of Medicare Advantage and dual integration programs.

“We’re just going to keep working along, we’re going to try to take care of as many people as we can, and do the best job we can,” Myers says. He explains that Oak Street does not make money by cutting out waste and spends the same on Medicare Part B that any other group would — but spends it differently, with savings gained from Part A. “That for us is the ultimate quality metric: people staying out of the hospital,” he says. “That’s the quality metric that happens to pay for what we do.”

He recommends that policymakers help where the majority are struggling and says he’s fine with “anything that improves the application of evidence-based, equitable, accountable care.”

From the NEJM Catalyst event Navigating Payment Reform for Providers, Payers, and Pharma, held at Harvard Business School, November 2, 2017.

More From New Marketplace
Comparison of Certain Model Features in Blue Cross NC Blue Premier vs Next-Generation ACO Model vs BCBSMA Alternative Quality Contract

Engineering a Rapid Shift to Value-Based Payment in North Carolina: Goals and Challenges for a Commercial ACO Program

We believe North Carolina can be a model for the nation.

Small Molecule Drugs Facing Generic Competition - Orphan and Non-Orphan Drugs - Orphan Drug Act

It’s Time to Reform the Orphan Drug Act

Three proposals for improving the law to reflect 21st-century drug development practices.

Three-Part Pricing of PCSK9 Inhibitors

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.

what does quality measurement in health care mean

Buzz Survey Report: Addressing the Problems of Quality Measurement

An independent NEJM Catalyst report sponsored by University of Utah Health on patient involvement in quality measurement.

Average HOOS and Average KOOS for patients undergoing hip and knee replacement at CJRI

Building a “Hospital-within-Hospital” Model for Joint Replacements

The Connecticut Joint Replacement Institute has demonstrated that formerly competing independent providers can unite on a common vision to yield drastic improvements in quality, safety, and costs.

Discharge Rates and Follow-Up Internval Dashboard for One Provider at MGH Dermatology

A Successful Pilot to Improve Access by Adjusting Discharge and Follow-Up Rates

Actionable data and modest financial incentives can help motivate clinicians to adjust their behavior around scheduling follow-up appointments.

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

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.

Strongwater08_pullquote primary care value proposition and disruptive innovation

The Evolution of Primary Care: Embracing Innovation While Protecting the Core Value

Primary care must leverage disruptive innovations to ensure that patients receive first-access, comprehensive, coordinated, continuous care that is woven into a seamlessly integrated system.

Berns01_pullquote nephrologists dialysis facility joint venture conflicts of interest

Dialysis-Facility Joint-Venture Ownership — Hidden Conflicts of Interest

Despite potential benefits, joint ventures between nephrologists and dialysis companies raise legal and ethical concerns because of participants’ conflicts of interest and lack of transparency.

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

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.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Engineering a Rapid Shift to Value-Based…

We believe North Carolina can be a model for the nation.

Engineering a Rapid Shift to Value-Based…

We believe North Carolina can be a model for the nation.

Bundled Payments

59 Articles

Building a “Hospital-within-Hospital” Model for Joint…

The Connecticut Joint Replacement Institute has demonstrated that formerly competing independent providers can unite on…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now