Health care institute hopes program will show if payment reform works

Is the much-touted value-based reimbursement model, in which providers get paid for care of a patient rather than per procedure, working?

It’s a question the Centers for Medicare and Medicaid Services Innovation Center is asking the public.

CMS has been the driver of the preventative care model, but is seeking a less top-down approach to health care cost curbing, according to New Jersey Health Care Quality Institute CEO and President Linda Schwimmer.

The timing is an interesting one for the state and the country. New Jersey is waiting for a new governor and the country is currently watching what happens to yet another Affordable Care Act replacement proposal.

The issue is an important one for New Jersey, which benefitted in some ways under the ACA — uninsured numbers are at historic lows, in part due to Medicaid expansion, and the number of insured patients has given a boost to the provider sector.

But the ultimate goal of lowering the cost of health care in all areas of the industry — including providers, health plans and life sciences — is yet to be fully realized.

New Jersey was recently chosen as one of three states, through the NJHCQI, to participate in a pilot program to track and score the payment reforms happening in the state, and how effective they are.

Catalyst for Payment Reform, a nonprofit corporation working to improve the quality of health care while also reducing costs, has previously worked with New York and Pennsylvania, Schwimmer said.

It has been working on scorecards to track health costs since 2013, and is now focused on value-based models through the new pilot program.

“Alternative payment models were created to better align the way we pay for health care with the outcomes we want for our health,” Schwimmer said in a recent statement. “The scorecard will report on the kinds of payment models that are being implemented in New Jersey and how they are working to improve outcomes and lower costs. We hope they are doing both.”

New Jersey likely showed up on CPR’s radar because of a relationship through the Leapfrog Group’s founding CEO, Suzanne Delbanco, Schwimmer said.

The HCQI’s former CEO and president, David Knowlton, served on Leapfrog’s board for several years.

Schwimmer said she has notified all insurers in the state about the pilot program, and will formally approach them to partner on the project.

Currently, Aetna, AmeriHealth New Jersey, Amerigroup, Cigna, Horizon Blue Cross Blue Shield of New Jersey, UnitedHealthcare and Wellcare have been notified. Oscar Health, which announced it is re-entering the state with a focus on health insurance for employers in 2018, has not yet been notified, according to Schwimmer.

The HCQI will not be receiving any funding for the program, but hopes it leads to either legislative or state-level transformation. The pilot program for CPR is being funded by grants from the Robert Wood Johnson Foundation and the Laura and John Arnold Foundation.

Delbanco, in a statement, said: “We selected the Quality Institute because of the organization’s independence and its history of creating and executing initiatives that drive improvements in health care quality and help to contain costs. We are excited to partner with the Quality Institute on this pioneering effort and hope it will support efforts toward better, more affordable health care for the citizens of New Jersey.”

Results are expected in August 2018.