Paying For Value: Perspective From The Front Lines (2016)
Toussaint et. al. Health Affairs Blog 5/24/2016
We propose that in a true pay-for-value system, a national payment rate should be established and rooted in reality (e.g., based on the costs of the top performing health care delivery organizations) and adjusted for three factors: a) risk of the patient population, b) geographic variation in the cost of doing business, c) patient outcomes. A detailed set of recommendations to setting the payment rate is provided below.
Key components of a successful global-based payment model
- 1. Reality-based pricing
- 2. Bundled payment and Per Member Per Year (PMPY) reimbursement
- 3. Margin
- 4. Secondary re-insurance
- 5. Patient involvement
