Specialty Payment Model Opportunities and Design: Environmental Scan for Neurology (Task 2)November 2014
Topics: Payment Models, Health Services Administration, Healthcare Economics and Organizations, Neurosciences
The current primary payment model for health care in the United States is fee-for-service (FFS), in which providers are paid separately for each individual component of care. Stakeholders interviewed for this environmental scan suggested that this payment model can promote the overutilization of services that are amply reimbursed but that do not necessarily improve the quality of care. Additionally, stakeholders noted that services that are not currently reimbursed by Medicare but that improve the quality of care, such as patient education and care coordination, are often under-provided. In an attempt to correct these problems with the FFS payment model, efforts are underway across the country to move toward value-based payment models that reward the provision of high-quality care rather than the quantity of services provided. Alternative payment models (APMs) attempt to promote the delivery of high-quality care by linking provider payment to measures of quality rather than volume or intensity of services. APMs also move toward case- or person-level payments that enable providers to work together more effectively and to have more flexibility in delivering care based on each individual patient’s needs. In this environmental scan, “care” constitutes any service that will help monitor, manage, or treat a patient’s medical concerns regarding a specific symptom, diagnosis, or procedure. While implementing APMs is challenging, these types of models are becoming more prevalent in many areas of health care.
The extensive evidence on alternative care models developed in complex chronic neurological care suggests that APMs in this space could lead to significant improvements in care. Developing and implementing sustainable APMs for patients with complex chronic neurological conditions is thus a critical element of the broader effort in the United States to improve health care outcomes and control total costs of care.
The Brookings Institution prepared this report for the CMS Alliance to Modernize Healthcare, which is operated by MITRE.