Understanding How Payment And Benefit Designs Work Together In Health Care

There is a lot of commotion around payment reform, with a proliferation of ways to pay health care providers and many different definitions of similar terms. This has led to efforts by experts and stakeholders in health care to define or classify payment methods — e.g. Harold Miller’s Payment Reform Glossary and the Learning and Action Network’s Framework. However, none of these has both defined and critically analyzed the various payment methods, or examined how they may interact with each other as well as the insurance benefit designs to which providers’ patients are subject. Speaking of benefit designs, they are evolving at almost the same rate; however, they have not been the focus of health care reform discussions, other than recently in the context of the Affordable Care Act (ACA) marketplaces. This is perhaps because Medicare and Medicaid benefit design is set by law and effectively frozen, whereas private health care purchasers are able to innovate freely. Thus, unlike for payment methods, there has been little to no effort to define and categorize benefit designs, and similarly no attempt to analyze their nuances. Creating Typologies With the help of a Technical Expert Panel, the Urban Institute and Catalyst for Payment Reform (CPR) partnered to define and categorize the payment methods and benefit designs available in the market into two “typologies” based on their characteristics. Our typology of payment methods classifies payments into two major ca...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Medicaid and CHIP Medicare Payment Policy ACOs Alternative Payment Models Catalyst for Payment Reform Payment Reform Landscape Source Type: blogs