Panel: Number of insurers, physician compensation pose barriers to payment reform

Wisconsin Health News Update – October 6, 2016

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The state’s high number of insurers and the way physicians are paid are among the barriers in the movement toward paying for value rather than volume, healthcare executives said this week.

Cheryl DeMars, president and CEO of the Alliance, said at a panel Tuesday in Madison the state isn’t leading when it comes to payment reform because it’s difficult to get agreement and alignment with so many payers.

“We know this is not a solo sport,” she said. “We’ve pulled together other payers who theoretically compete with us to see if we can align on common quality measures. Other purchasers too – and it’s been difficult.”

That’s because purchasers don’t have to change and don’t have to collaborate, according to DeMars. Another barrier is mindset, she said.

“I can’t count the number of times we’ve talked about different ways to pay for healthcare and the need to shift from volume to value and somewhere along the line around the table, inevitably, someone will lean over and say ‘How do I stay home on this?'” she said. “That’s the problem. None of us can stay home and still create the magnitude of change that we need in healthcare.”

Mark Xistris, vice president of provider relations at WPS Health Insurance and Arise Health Plan, cited models like the Alliance’s QualityPath as a good way to pay for value at the procedure level.

“One of the barriers I think is also the difficulty in tackling physician compensation reform because you just have an inherent disconnect,” he said.

If compensation is based on productivity, and revenues aren’t based on that, “that’s a real big issue,” he said.

Dr. Jeff Bailet, co-president of Aurora Health Care Medical Group, said that moving away from the productivity model requires a “strong, unified group culture” and a “cultural shift.”

“I think that when that work is done and we start to make a significant movement in changing outcomes and washing out that non-value-added work, we will discover things that will help us refine the next phase of payment reform that will come down the road,” he said.

Jo Musser, Wisconsin Health Information Organization CEO, said Wisconsin has one of the most competitive insurance markets in the nation. And she noted that a number of provider-owned plans take on global capitation and a large amount of risk.

“As payers, whether it’s self-funded employers or insurance plans, we can’t really direct payment the way we would like to inside a medical group,” she said during a question-and-answer session. “There’s some challenges there, but there’s some real successes in Wisconsin as well.”

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