Sorting through the new reimbursement models

An assortment of new payment models are available in attempts to fix the fee-for-service imbalance

The entire healthcare community is looking for ways to reduce costs and confusion, while yielding better patient outcomes. New reimbursement models being tested by Medicare, private payers and think tanks aim to consider all the entities in the payment process—and they all have their advantages and their drawbacks.

While many primary care physicians (PCPs) welcome the change, Jill Rubin Hummel, vice president of payment innovation at WellPoint, Inc., says she is often asked for advice on how to sort through the many new reimbursement models that are emerging.

“I always tell them that the days of fee-for-service medicine as they know it are really numbered,” she says. “The movement to value-based payment can take many forms, but the concept of not just paying for value but for the quality of the care delivered will, over time, become the new normal.”

 Marci Nielsen, PhD, MPH, chief executive officer of the Patient-Centered Primary Care Collaborative, says that for any new model to work, it is important that physicians not have to carry all the risk. Risk needs to be shared and adjusted; otherwise, it will be like the dreaded capitation of the past.

 “This is so different than the 1990s. We have much better access to information to improve risk adjustment,” Nielsen says. Moreover, she adds, many of the models now being considered have arisen from providers themselves, rather than being forced on them by payers.

 So which options are winners and which are losers for PCPs? Medical Economics recently posed that question to a variety of experts.


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