Which Value-Based Reimbursement
Model Will Ultimately Align Physicians?

Move over, ACO: a new payment model in town "has an excellent chance of coalescing value around a single model," according to Greg Mertz, MBA, FACMPE, managing director of Physician Strategies Group, LLC.

It's not yet law, but the federal "Better Care, Lower Cost Act" introduced last month circumvents the ACO's attribution model, which Mertz describes as "loosey-goosey," and targets the sickest and highest cost patients, who are also eligible for financial incentives if they play by the Act's health management rules. In Mertz's eyes, the ACO has a limited life span.

Touching briefly on the proposed legislation, Mertz all but left the accountable care organization off his list of six value-based physician compensation models explored during the Physician Alignment: Which Model Is Right for You? workshop sponsored by the Healthcare Intelligence Network — except as a footnote under Population Management, a model Mertz described as still evolving.

Greg Mertz

And while three-quarters of healthcare leaders agree that quality is driving the need for alignment around a preferred reimbursement model, the simple presence of physicians in a hospital does not translate to alignment.

Instead, the financial catnip of incentives will draw physicians to collaborative efforts, he said. Mertz moved workshop participants along a "collaborative continuum" of alignment from an environment of "mutual toleration"—the state of many two- to four-doctor practices today where planning can be challenging—to Population Management, a model he termed "the least defined, most questionable of the value models right now."

In all, Mertz explored the following six models:

  • Process Improvement
  • Physician-Hospital Organization (PHO)
  • Shared Savings
  • Case Pricing/Bundled Payments
  • Co-Management
  • Population Management

To guide workshop participants, Mertz presented examples of a small rural hospital, a competitive community hospital, and a large health system, outlining the challenges, likely realities and possible reimbursement models for each.

In case you missed this webinar, you still have a chance to watch this highly-rated program.

Register to view the conference today or order your training DVD or CD:
http://store.hin.com/product.asp?itemid=4819

It’s so convenient! Invite your staff members to watch the conference. We will send you a DVD or CD-ROM of the conference proceedings or a link to our web site with a username and password. You can log in and view the program right from your computer — any time of the day or night, whenever convenient for you and your colleagues — and benefit from the archived recording of the conference, including the Q&A period.

You'll get to listen to the question and answer session to hear more on: key performance metrics for incentive-based reimbursement systems; the role of physician citizenship in value-based systems; characteristics of physician thought leaders who can help engage other physicians; recommendations for incentive payout frequency; high-cost procedures addressed by shared savings agreements; incentives for provider staff who implement processes and drive outcomes; guidelines for specialist compensation; addressing patient access challenges in value-based systems; and how ACOs are evolving.

To register for the on-demand re-broadcast, download an .MP3 file or order the training DVD or CD-ROM of Physician Alignment: Which Model Is Right for You?, please visit:
http://store.hin.com/product.asp?itemid=4819

I hope you find it useful.

Cordially,

Melanie Matthews
Executive Vice President
The Healthcare Intelligence Network

P.S. -- You may also be interested in these resources on value-based reimbursement: