Data readouts

Innovative Incentives for a New Model of Health Care

By Scott Fields, MD

Many people are working to develop methods for value-based pay. In fact, the US government aims to tie 50 percent of Medicare payments to value or quality by the end of 2018. And the State of Oregon also hopes an Alternative Payment Methodology (APM) will create opportunities to change the system of care. They are changing the way people are paid by changing the incentives for work that is done.

The first three clinic systems to launch the APM pilot are helping to lead the way. They were working to develop innovative care delivery even before APM, so it would be unfair to look at these cutting edge, raise-my-hand clinics, and say that nothing is measurably different.  APM has not created innovation, but rather it creates the opportunity for innovation.  We’re trying to engage the entire community to do something different, and that’s where the innovation is happening. To succeed at this, we need to make sure that incentives are aligned correctly.

Our clinical team is looking at how people are responding to the new incentives. Many different types of outcomes may answer the question: What is the health care system doing differently than it has done in the past? You can look at what people are doing differently in the clinics and whether clinicians have changed their behavior. You can measure what happens to our patients, which is what we really care about. And within that measure you could look at what types of services they receive or what happens to their health. Once we determine if patient health has changed, we can decide if we were successful—at least in one dimension. Continue reading Innovative Incentives for a New Model of Health Care


Measuring the New Doctor “Visit”

Team-based Care Requires Team-based Metrics

 By Jen Coury

The old adage goes, “You get what you pay for.” But what are you paying a health care provider for if it’s not a doctor’s visit? The Alternative Payment Model (APM) has shifted payments away from the number of clinic visits with a doctor and towards a per-patient monthly rate. This means that somehow the health care systems in the pilot need to demonstrate what care they are delivering. But measuring population-based health management is a lot trickier than counting how many times a patient walks through the door of the clinic.

What defines success? The State, Oregon Primary Care Association, and the health care systems taking part in the APM Pilot have been working together to answer this question. The ideal health care scenario is to deliver the right care, at the right time, to the right person. They are working towards a metric that captures the accountability of a health care provider.

Ultimately, the State will want to pay primarily for health outcomes, but that’s a long way from now. For example, if you think of a health care system as managing the health of a population (in the new model), then one measure might be what percent of the population is the provider in touch with. Meanwhile, we have to pay health providers while moving towards this future ideal model of care. Continue reading Measuring the New Doctor “Visit”