This report provides results of a study – the largest and most comprehensive of its kind – measuring use of Alternative Payment Methodologies (APMs) among public and private health plans that agreed to participate in the study. Conducted from May 19, 2016 to July 13, 2016, the findings capture actual health care spending from 2015 and provide an estimate of spending as of January 2016 across commercial, Medicare Advantage, and Medicaid market segments.
The report is designed to help leaders - including providers, payers, and employers - who are working, or wish to work, in alternative payment models (APMs) to understand what information they will need from outside their organization and the processes involved in obtaining that information. It is also an aid for third party entities, including vendors, policymakers and others that provide access to the data sources and data sharing processes that support APM efforts.
Stakeholders who are developing Alternative Payment Models (APMs) face a number of challenges, and those implementing or receiving care supported by APMs have concerns about APM design and potential negative consequences poorly-constructed APMs may have on patients, providers, payers and communities. Recommendations for addressing eight of these challenges were developed by the the 80 national health care leaders who participated in the 2016 National Payment Reform Summit.
Many physicians, hospitals, and other providers across the country find that the current fee–for–service payment system creates
barriers to implementing or sustaining better approaches to health care delivery. Consequently, payment reforms must be an integral part of
any strategy to create a higher–value health care system. This white paper describes the building blocks for successful payment reform and how communities might approach these building blocks to meet their unique circumstances.
This document features advice from leading Regional Health Improvement Collaboratives (RHICs), including ones in California, Ohio, Colorado, Maine, Minnesota, Oregon, and Missouri,that have been advancing their communities toward greater transparency of cost and quality information for years and overcoming barriers of all kinds.
This issue brief describes why the industry must move beyond common but insufficient methods of measuring cost of care, and toward total cost
of care, and what types of entities are well-positioned to lead this work. It presents five core components of measuring, analyzing, and reporting total
cost, and presents the challenges associated with this task.
The Network for Regional Healthcare Improvement (NRHI) released a series of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) based webinars to help clinic staff, administration and providers prepare for upcoming changes. View more information and access links to these webinars here.
The Patient-Centered Primary Care Institute, in partnership with the Oregon Health Authority's Transformation Center, has created an area on the Institute website where you can find information, tools, and resources for Clinician and Organizational Vitality. Centered around addressing stress and burnout, these resources are for anyone working in health care that may benefit from wellness resources and tools.
Nasreen Abdullah, Robert S. Laing, Susan Hariri, Collette M. Young, & Sean Schafer published a study using Q Corp claims data on how to estimate the percentage of women in a geographic population that have had cervical cancer screening. Their nfindings introduces a novel method to estimate population-level cervical cancer screening. Overall, the percentage of women screened in Portland, Oregon fell following changes in screening recommendations released in 2009 and later modified in 2012.
Clinicians are often the first to see the contributors to and consequences of poor health behaviors. Thinking of ways to help our communities address these issues can be of great importance and contribute to a sense of meaning within the community.
Over three years, Regional Health Improvement Collaboratives, working collectively through the Network for Regional Healthcare
Improvement, have demonstrated the ability to assess, refine and standardize raw regional healthcare cost data and use it to establish meaningful, local practice level reports and comparisons within and between healthcare markets. This work advances healthcare cost transparency, a necessity for solving the healthcare cost crisis. This report summarizes key findings.
NRHI has launched its Learning Module series, aimed at enabling participants to learn first-hand from the HealthDoers in the field. Join the Getting to Affordability social learning community at this link to access the eight modules that provide training on technical and stakeholder engagement aspects of measuring and reporting Total Cost of Care (TCoC) locally and regionally. In the community you can also access resources, and talk with the TCoC project team and other community members.
The Network for Regional Healthcare Improvement (NRHI) and the APCD Council are pleased to announce the release of the Technical Resource for Measurement of Total Cost of Care (TCOC) using Multi-Payer Data Sets. The standardized technical specifications and lessons learned from the TCOC pilot regions have been translated into a more formal how-to guide for measuring and reporting total cost of care.