16 challenges in healthcare payment reform

The Bipartisan Policy Center has issued a new report that seeks to identify the specific challenges and opportunities the U.S. Department of Health and Human Services faces in implementing healthcare reform. Notably, many of the problems identified in the report are the same as those pointed out by healthcare industry executives and the organizations that represent them.

The similarity in concerns between those the Bipartisan Policy Center report authors and those of healthcare industry organizations is particularly telling in the area of Accountable Care Organization (ACO) formation. Both agree that the current system for Medicare ACOs — where beneficiaries are unaware they have even been assigned to an ACO and providers don't get ACO patient healthcare utilization data in a timely fashion —  is unworkable.

The 16 challenges the Bipartisan Policy Center identified include:

1. Improving quality while also slowing the rate of healthcare cost growth — in other words figuring out how to get more while spending less.
2. Getting widespread provider participation in new and unfamiliar alternative payment systems that aim to reward quality of care and not quantity of care while simultaneously being limited in the amount of dollars that can be handed out to entice reluctant providers to try the newer systems.
3. Structuring incentives to incorporate the full range of providers, not just primary care physicians.
4. Facilitating the establishment of alternative systems of care in rural areas where newer ACO and risk-based payment models may not work as well.
5. Structuring new payment models to engage specialists.
6. Getting beneficiaries more engaged in ACOs and favoring their “in-network” providers. Currently, most do not even know they’ve been assigned to an ACO and have no incentive or pressure to stick with in-network providers
7. Develop a limited and universal set of quality measures that is meaningful but not too complex.
8. Provide timely and useful performance and benchmark data to providers in an ACO so that they can understand if efforts to control costs for beneficiaries assigned to the ACO are working.
9. Make the complex healthcare pricing and quality system transparent and useful to beneficiaries so that they can make sound decisions about what care they want to receive and who will provide it.
10. Provide adequate technical assistance to providers despite the government's limited budget for such assistance.
11. Make electronic health records more interoperable despite a limited number of ways to incentivize such interoperability.
12. Monitor to make sure healthcare market consolidation driven by healthcare reform does not inadvertently drive up prices.
13. Determine the appropriate role of telemedicine.
14. Create a critical mass of patients who are seen under alternative payment models so that these models are financially viable.
15. Create consistency in quality measures as well as contracting and reporting requirements across payors.
16. Continue innovation and testing of new models while facing a constrained budget for future studies.

Founded in 2007 by former Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell, the a non-profit Bipartisan Policy Center seeks to combine “politically balanced policymaking with strong, proactive advocacy and outreach.” Read the report here.