DENVER--(TriZetto Corporation, shared insights into emerging models of care with the country’s largest public pension fund and with the White House Office of Science and Technology Policy (OSTP) during separate, recent engagements. TriZetto is an acknowledged leader in providing information systems and consulting solutions that help healthcare payer and provider organizations adopt accountable care and other new care-delivery models.)--Jeff Rideout, M.D., senior vice president and chief medical officer of
“There was a lot of discussion about the lack of standardized reporting on new models of care such as accountable care organizations and payment bundling”
In remarks before the California Public Employees’ Retirement System (CalPERS), Rideout helped educate its board on payment-bundling strategies. One form of “episodic payment” or “value-based reimbursement,” payment bundling either prospectively or retrospectively provides a single payment to all the physicians and facilities involved in administering medical care throughout an entire episode, such as a patient’s hip replacement.
“The idea behind payment bundling is to help shift the healthcare system from fee-for-volume to fee-for-value, to optimize the coordination of providers and thereby improve clinical outcomes,” said Rideout. “But of course the devil’s in the details. We discussed health conditions that lend themselves to payment bundling, the conditions that ensure providers are prepared to manage care in this way, how to set and execute payments, how to establish reporting and accountability and the technology that is necessary – in general, all that is required to administer such a program.”
Rideout complimented CalPERS, which provides health benefits for 1.3 million enrollees, for its energy and leadership. “The organization is trying to accelerate the adoption of accountable care models in California. Board members are knowledgeable and engaged already. CalPERS is a pacesetter among the state’s purchasers, health plans and providers in advocating, vetting and ultimately piloting these promising approaches.”
Rideout participated, as well, in a meeting of the White House OSTP, co-hosted by the Clinical Excellence Research Center of Stanford University’s School of Medicine. Titled “Mobilizing Science and Technology to Lower Costs and Improve Outcomes,” the healthcare session was modeled on previously successful efforts by the OSTP in the fields of technology and computer science.
“There was a lot of discussion about the lack of standardized reporting on new models of care such as accountable care organizations and payment bundling,” Rideout said. “For instance, the FDA provides a standardized evaluation and authorization of prescription drugs. No such governmental body exists to assess the effectiveness of new models of care delivery. The CMS offers some of this through its demonstration projects, but there is at least as much innovation occurring in the commercial sector and very little of this is being reviewed and disseminated. We really lack standardized mechanisms to determine the efficacy of care models, what works, what doesn’t and how best to share validated results and lessons learned.”
The meeting was part of an effort by the executive branch of government to gather recommendations from national leaders such as Rideout on how research funding and innovation adoption policies can safely lower costs and improve outcomes. Output from what is billed as an ongoing “national dialogue” will inform policy recommendations that address biomedical technologies, behavioral science relevant to changing patient and health workforce behaviors, health information and communications technologies and health service redesign/systems engineering.
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TriZetto delivers world-class information solutions that enable healthcare organizations to work more efficiently and collaboratively to deliver better health. Its solutions reach 200,000 care providers, streamline processes for more than 360 payers and touch over half the U.S. insured population. TriZetto solutions help health plans and TPAs increase administrative efficiency, improve the cost and quality of care, and succeed in the retail healthcare market. Its solutions help physicians and health systems simplify business processes and execute strategies for population health management and accountable care. TriZetto’s healthcare experience, innovative solutions and comprehensive services help simplify healthcare for everyone. For more information, visit www.trizetto.com.