Albany partner Matt Amodeo was quoted in a Benefits Pro article titled, “Chaos Theory.”
As the notion of “value-based payment” has taken hold in the health care market. Value-based payments is the concept that health care providers should be paid according to the quality of care they offer, as opposed to today's “fee-for-service” payment method. As a result, insurers, from the Centers for Medicare & Medicaid Services to commercial payers, have had to define and measure quality and value in health care.
How those quality metrics are defined and collected, and how the payment measures are structured, vary from payer to payer as they experiment with various models to test what's most effective.
“Payers might develop quality metrics based on, for instance, performance levels determined nationally by top-tier providers, so they’re setting the benchmark very high,” explained Matt. “A commercial payer could look at the highest-scoring, highest-quality cardiology group in the country and use that to set their benchmark for the cardiology providers participating in that commercial payer's [accountable care organization]—and those metrics might look nothing like Medicare's metric,” he said.
“Most commercial payers have developed their own proprietary population management programs, and by programs, I mean hardware, software and personnel. They have all the data for the attributed population, and they can more easily distill this data and provide it in reports that are easily digested and understood by their network providers. Sometimes the provider can request certain data elements organized in a specific way, and sometimes the payer can accommodate that and provide ad-hoc reports that are customized. Payers are providing resources,” Matt said.
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