9 Ways to Improve Healthcare Policy for Better Cost Reduction, Innovation

September 27, 2016

This article originally appeared at http://www.fiercehealthcare.com/healthcare/9-keys-to-improving-healthcare-policy on Sept. 20, 2016. 

By: Zack Budryk  | September 20, 2016

While alternative payment models in healthcare have made significant progress, challenges remain, particularly in light of exits from accountable care organizations (ACOs), and several key recommendations could help leaders improve care policy.

Researchers at Premier Inc. collaborated with hospitals, physician groups and health systems nationwide to analyze effective care delivery strategies, according to a new report (.pdf). The reforms, according to Premier, are designed to offer more flexibility for care innovation, cost cutting and quality improvements.

“While we have come a long way on our journey toward a reformed delivery system with value-based payment models, we’ve also uncovered some unintended consequences,” Blair Childs, senior vice president of public affairs at Premier, said in a statement. “Some current policies, while well-intended, are overlapping, confusing and sometimes unfair. Premier’s recommendations present a more comprehensive framework that removes barriers standing in the way of higher quality, more efficient and coordinated care.”

Premier’s policy recommendations cover several care models and issues, including:

  • ACOs: Policymakers should streamline the Medicare Shared Savings Program, offering such improvements as further shared savings for the top performers and flexibility within the risk continuum.
  • Legal obstacles to care integration: To protect ACOs, policymakers should cut through regulatory barriers and add exceptions to anti-kickback regulations and physician self-referral rules.
  • Improved data access not only for Medicare, but Medicaid and Veterans Administrations Data.
  • Layered payment model demonstration to test the pairing of primary care capitation and bundled payments within Medicare ACOs.
  • Improved interoperability within health information technology to de-silo information between providers and sectors.
  • Consolidation among pay-for-performance programs: Policymakers must remove redundancies in pay-for-performance penalties, streamlining the existing five programs into one.
  • Value-based purchasing programs for critical access hospitals: Healthcare should target high-risk rural areas through care delivery programs tailored specifically to such environments and needs.
  • Engagement with beneficiaries embedded in each program at all levels, including transparency, benefit design and measurement.
  • Provider-based outpatient clinics: Policymakers should develop payment policies that allow provider-based clinics to help reduce healthcare spending and better coordinate care, with site-neutral payment exemptions for ACO-run provider-based clinics.
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