Paying for Value and Delivering Value in Health Care

When we see a doctor or need hospitalization, we don’t usually ask, “did I get a good value?”  The future of health care may depend on that very question.  Health care transformation work underway at the national and state level is based on creating incentives for health care to be delivered in a way that value is rewarded.  That means keeping patients healthy becomes as much a part of a health care provider’s job as treating someone when they are sick.

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Greg Moody and Will Shrank, MD

Structuring our health care system for value was the topic of a conversation August 5 at the Greater Cincinnati Health Council where CEO Craig Brammer hosted Greg Moody, director of the Ohio Office of Health Transformation and Will Shrank, MD, assistant clinical professor of medicine, Harvard Medical School and Brigham and Women’s Hospital and a former top official at CMMI the Innovation Center for the Federal Office of Medicare and Medicaid.

Moody provided a snapshot of value centered reform efforts at the state level, including its actions to modernize Medicaid and streamline health and human services combined with steps initiated this year to pay for value. He shared the state’s work plan for the next five years in the areas of Patient Centered Medical Homes and evaluation of episode-based payments. “You all are deep into the intricacies of what it takes [with PCMH],” he told attendees, “and we see opportunities to take that to scale statewide.”

Dr. Shrank shared insight he gained from working as director of the Rapid-Cycle Evaluation Group at CMMI and from leading the evaluation of a health reform research agenda to develop and test new payment models aimed at reducing the cost and improving the quality of care in the U.S. He analyzed the range of care delivery transformations and initiatives funded by the Innovation Center that providers can choose from and their escalating amounts of risk.

Shrank emphasized the need at CMS for payment models and communities that are highly effective. Rapid cycle evaluation of what works and what doesn’t means that “we can’t make decisions based on bad evidence,” he said. He cautioned that “payment reform without better data or vice versa will fail – these are two things that have to happen together. And Cincinnati is the hotbed to do this. You’ve got all the features: the best health information exchange in the country, engaged employers and hospitals. Cincinnati should be and is the best testing ground in the U.S.”

Related to the new round of CMS Health Care Innovation Awards, Craig Brammer – CEO of the Greater Cincinnati Health Council, Health Collaborative and HealthBridge – shared with attendees an overview of a proposal being prepared for CMS by these three organizations for the Greater Cincinnati region focused on post acute care transformation that incorporates both care delivery and payment reform.

This event was part of a continuing Thought Leadership Series hosted by the combined operations of the Greater Cincinnati Health Council, Health Collaborative and HealthBridge that brings outside experts to the region to provide perspective on Greater Cincinnati’s strategies to improve care and health while reducing costs.

 

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