Over the last four decades, both the public and private sectors have experimented with payment approaches designed to change provider behavior, motivating providers to deliver better care at lower cost.
Since the RAND Health Insurance Experiment, RAND Health Care has led the way in efforts to understand the links between physician payment, quality of care, and system cost.
To help the Centers for Medicare & Medicaid Services (CMS) reimburse primary care practices for investing in "comprehensive primary care," RAND developed and piloted a method for estimating related practice expenses.
The U.S. Department of Defense (DoD) and U.S. Department of Veterans Affairs (VA) both use private-sector contracts—known as "purchased care"—that govern how beneficiaries see community-based health providers. How feasible is it to integrate the VA and DoD approaches to purchased care?
It is difficult for physicians to keep up with changing payment models, navigate complexity, and invest in data and reporting. Slowing the rate of change and simplifying payment models can help physicians improve patient care and earn financial benefits.
Physician practice engagement with alternative payment models (APMs) would be enhanced by simpler APMs, a slower pace of change, greater support for new capabilities and timely data, and reexamination of practice response to APMs with financial risk.
The New York Health Act could provide insurance to all New York State residents without increasing overall spending if administrative costs are reduced and growth in provider payment rates is restrained. New taxes, instead of premiums and out-of-pocket payments, would finance the program.
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