When you look at the health care delivery system do you find

When you look at the health care delivery system do you find other ways that the goverment might change the payment system to avoid fraudelent activity by providers?

Solution

BARRIERS

SOLUTIONS

BARRIER #1:Continued use of fee -for-service payment in payment reforms

SOLUTION: Use episode-of-care payment for acute conditions and global payments for all patients to eliminate undesirable incentives under fee-for-service and to give providers the flexibility and accountability to reduce costs and improve quality

BARRIER #2:Expecting providers to be accountable for costs they cannot control.

SOLUTION: Use risk adjustment and risk limits to keep insurance risk with payers but transfer performance risk to providers.Use risk exclusions to give providers accountability only for the types of costs they areable to control.Make provisions for contract adjustments to deal with unforeseen events

BARRIER #3:Physician compensation based on volume, not value

SOLUTION: Change physician compensation systems to match incentives under payment reform. Modify federal and state fraud and abuse laws to permit gain-sharing between hospitals and physicians

BARRIER #4:Lack of data for setting payment amounts

SOLUTION: Give providers access to timely analyses of both utilization and costs through community multi-payer claims databases

BARRIER #5:Lack of patient engagement

SOLUTION: Ask patients to designate their primary care physicians rather than using statistical attribution rules based on fee-for-service claims to assign them retrospectively. Use value-based benefit designs to enable and encourage patients to improve health,adhere to treatment plans, and choose high-value providers and services