Bonnie Austin Cluxton is a Vice President at AcademyHealth, where she leads the organization’s strategic plann... Read Bio
Additionally, AcademyHealth built on lessons learned from RWJF grantees and other payment reform efforts occurring across the country in order to accelerate the development and application of successful payment and delivery system reform strategies.
Enrique Martinez-Vidal is vice president at AcademyHealth overseeing the organization’s state-focused portfoli... Read Bio
Payment Reform: Honing the Models and Pushing the Boundaries
October 23-24, 2014 | Chicago, IL
What Needs to Happen "Under the Hood" for Payment and Delivery System Reforms to be Successful
February 27-28, 2014 | Washington, DC
Building Blocks for Payment Reform: Data and Relationships
June 26-27, 2013 | Baltimore, MD
Reports & Publications
Three Emerging Challenges for Sustained Payment and Delivery System Reform
This brief summarizes three emerging challenges that will need to be addressed to assure the long-term success of payment and delivery system reform. It also provides examples of current activity in each area and identifies issues for future exploration and strategy development.
Four Innovative Strategies to Help Providers Succeed Under Payment Reform
Providers and payers have initiated new activities to ensure that the implementation of new payment models are driving improvements in the quality of care and reducing health care costs. This brief summarizes the innovations in provider-based payment reform activities that are implement across the county, and identifies characteristics that position organizations for success in these efforts.
A Burning Platform and Trust: Key Ingredients for Payment Reform
In case studies of successful payment reform efforts, two factors were seen: a) a burning platform to motivate action through fear; and b) trust that allows people to work together in the face of uncertainty. This brief explores these concepts to understand how to facilitate movement toward fundamentally different payment and delivery models than those that have dominated American health care until now.
Training & Resources
Pushing the Boundaries: Emerging Innovations in Payment and Delivery System Reform
This three-part webinar series examined several innovative payment reform models that are pushing the boundaries of the field and are driving the change to a population-based, whole person-focused delivery system
- Webinar I: Treating the Whole Patient: Addressing Social Determinants of Health
- Webinar II:Payment to Support Integrated Behavioral Health and Primary Care
- Webinar III: From Top to Bottom: Distributing the “Payment Underneath the Payment"
Transforming Health Care Payment and Delivery Systems on the Ground
To improve health care quality and contain costs we must reform both payment and delivery systems, but can every initiative overcome the challenges of operationalizing dual reforms? This three-part webinar series examined the integral connection between payment and delivery system reform by looking at on-the-ground approaches for transforming systems through innovative models of care management, clinical infrastructure redesign, and data sharing.
- Webinar I: Population-Based Approaches to Care Management
- Webinar II: Harnessing Your Organization's Big Data to Improve Outcomes, Reduce Costs, and Improve Service
- Webinar III: Unlocking Capacity for Health Care Transformation
In order to support improvements in both health care delivery and payment systems, individuals and organizations that purchase health care services and health care providers need a clear business case showing that proposed changes in care will achieve sufficient benefits to justify payment change. In this webinar, Harold Miller describes a 10-step process to develop such a business case and shows how to apply the process to specific examples. This webinar is offered in conjunction with the recent publication of a related issue brief.
Regional Health Improvement Collaboratives, Health Information Exchanges, states, and the federal government can play important roles in facilitating the ability of various stakeholders to obtain and use data effectively for payment and delivery reform, but it is important to obtain the right kinds of data and make them available in the right ways. This webinar describes the key types of information needed during the planning stage of payment reform initiatives, the design/pricing stage, and the implementation stage, and it provides specific examples of how data can be used to support payment and delivery reform efforts.
Pilots & Programs
AcademyHealth oversaw and provided technical assistance to nine RWJF payment reform grantees that are implementing innovative payment reform projects in their communities. Below is a brief overview of each grantee’s initiative.
Piloting Population-Based Health Metrics for ACOs
The Maine Health Management Coalition Foundation
To advance payment reform efforts that have been emerging across the state, Maine Health Management Coalition Foundation (MHMC) supported a variety of activities, including public reporting of system transformation; developing a tool for risk modeling and prioritization; and providing data analytics for benchmarking and adjudication of risk contracts. For more information on this grantee, visit here.
Program Oriented Payment Demonstration Project
Physicians Choice Foundation
This project aimed to test an innovative model known as Program Oriented Payment (POP). The model attempted to manage a pool of funds from which real-time incentives could be paid to the team of providers caring for a patient with three chronic conditions (congestive heart failure, chronic obstructive pulmonary disease, and diabetes), if the care met clinical guidelines and helped meet the patient's goals. For more information on this grantee, visit here.
Novel Provider Payment Incentive Modeling in a Community-Based Accountable Care Network
Pittsburgh Regional Health Initiative
This project is using an accountable care network (ACN) to overcome a variety of key barriers and demonstrate substantial cost savings in the form of the reduced use of hospital services. PRHI is basing this network on a carefully constructed payment reform model that keeps physicians and hospitals financially whole in the payment transformation, and accelerates the redesign of care in ways that create high-quality, efficient care with substantial cost savings. For more information on this grantee, visit here.
Accountability through Transparency and Informed Design: The New Hampshire Accountable Care Organization Pilot Project
NH Citizen’s Health Initiative, University of New Hampshire Institute for Health Policy and Practice
The NH Accountable Care Project is a group of healthcare leaders, employers, and citizens actively working to utilize common measures, benchmarks, and reports of healthcare costs, utilization, and quality to support payment reform and system transformation efforts in New Hampshire. This project convened an array of healthcare perspectives for thoughtful discussion around relevant analyses to support system transformation in NH. For more information on this grantee, visit here.
Transforming Payment for Oregon’s Community Health Centers through an Alternative Payment Methodology
Oregon Primary Care Association
Oregon Primary Care Association (OPCA), in collaboration with the state Medicaid agency, has developed an Alternative Payment Methodology (APM) for Community Health Centers (CHCs). The APM will convert the CHCs’ prospective payment system rate to a capitated equivalent in order to enhance population management, comprehensive and coordinated care management, full implementation of patient-centered care teams, and integration of actionable data into daily practice management. For more information on this grantee, visit here.
In conjunction with this initiative, OCHIN and the Oregon Health & Science University Department of Family Medicine are collaborating to share real-time findings from OPCA’s work. Their evaluation efforts, in addition to other relevant health transformation news, are featured on the blog, Frontiers of Healthcare.
Maternity Episode Bundled Payment
Pacific Business Group on Health
This project includes a three-pronged approach to address medically-unnecessary C-sections and improve the quality of maternity care in California: 1) payment redesign for deliveries (blended payment for hospital; pay for performance for physicians); 2) quality improvement programs for participating hospitals and medical groups; and 3) data support for participating hospitals and medical groups. For more information on this grantee, visit here.
Redesigning Medicaid Payment Policies: A New Pathway for Achieving High-Value Care for Medically Complex Children
UPMC for You, Inc.
Stakeholders in Allegheny County, Pennsylvania are developing a new pathway for Medicaid payment reform that will enhance the value of care for children with medically-complex conditions. The project moves beyond traditional Medicaid fee-for-service (FFS) reimbursement to a value-based payment structure for providers caring for children with medically-complex conditions, and provides families with consumer-directed accounts to obtain the goods and services they need and value most for their child’s well-being. For more information on this grantee, visit here.
Development of Models for Comprehensive Payment Reform in Vermont
Vermont Green Mountain Care Board
Vermont Green Mountain Care Board is implementing multiple initiatives that identify and promote promising payment and delivery system reforms for sustainable high-value care. They include: 1) Northeastern Vermont Oncology Pilot, which is designed to reduce avoidable utilization of services and overall expenditures related to cancer care; 2) Bundled Payment for Care Improvement for Congestive Heart Failure; 3) Medicaid and Commercial Accountable Care Organization Shared Savings Programs; and 4) Global Budget Payments for services provided by two regional hospitals. For more information on this grantee, visit here.
Development and Implementation of Payment Reform to Pay Equally for What Works Equally Well
Institute for Clinical and Economic Review, Massachusetts General Hospital
This project attempted to use comparative effectiveness research to inform payment changes for the treatment of low-risk prostate cancer. For more information on this grantee, visit here.