At the Quality Institute, we begin 2019 with a baseline for where we are on payment reform in New Jersey — and a greater understanding of the challenges ahead.
As the lead New Jersey partner of Catalyst for Payment Reform’s (CPR) Scorecard 2.0, we worked with CPR as they assessed payment reform activity in New Jersey based on 2016 claims data. The organization also analyzed additional data to determine where New Jersey stands on key quality measures and interviewed health care leaders to assess views on payment reform.
Last week CPR and the Quality Institute released the last two parts of the Scorecard — the Medicaid Report and the Leaders Perspective Report. I encourage you to take a look at both along with the methodology report, which is all here on our website.
The analyses found that New Jersey has lower levels of payment reform activity in its Medicaid program than in its commercial market. There are several explanations for this, but the good news is that the Murphy administration has voiced support for alternative payment models, and we are optimistic that innovative models successful in other states soon will be used here.
Driving payment reform will be one of our priorities in 2019.
When we issued the first part of the CPR Scorecard 2.0 last year, we asked providers on the forefront of payment reform along with purchasers seeking higher quality care and affordability to tell us about their efforts. What are they doing successfully, and how are they paid? We also asked about the changes they believe still are needed. Their advice provides a valuable roadmap for anyone who wants to work with us to drive reform.
First, providers said the keys to their current success with alternative payment models are:
- Models designed to deliver high quality care. The providers said they do this work for their patients and to pursue the triple aim.
- Meaningful and actionable metrics that can be viewed and shared at the physician or provider level.
- Support and coaching to the practices to set up the structure and processes to do this work successfully.
- Embedded care coordination programs into every model.
These innovative providers and payers also shared what they need to move aggressively to alternative models that include downside risk:
- Aligned models with the same measures and same reporting requirements regardless of the payer. They do not want to treat patients differently based on patients’ different insurance plans.
- A commitment of support and partnership for the work from the larger system, including regulators, consumers, technology companies, other providers, and payers.
- Joint ventures and financial supports for the work, which is time consuming and expensive.
- Interoperability and integration of systems so providers understand the care their patients are receiving outside the physician office.
- Greater control over care beyond the physician office, such as what type of procedures and medications patients may be receiving in other care settings.
- Removing prior authorization requirements when participating in a shared risk model.
The start of the year provides us with an opportunity to reflect on what we have learned from those on the front lines of these innovative models and to build on those lessons.
The providers and payers who shared their insights with us witnessed the benefits of these models first hand and understand the day-to-day challenges of implementation. At the Quality Institute, we’ll continue to work with and learn from these innovators — and we invite you to join us in this pioneering effort to improve our health care system.