Karen Timberlake, director of the Partnership for Healthcare Payment Reform (PHPR) in Wisconsin, shares her insights on implementing new payment reform pilots.The Partnership for Healthcare Payment Reform (PHPR) is a unique collaboration of healthcare providers, payers, employers and consumers dedicated to tackling the complex challenge of providing quality healthcare, while reforming a frequently cumbersome payment structure. PHPR, an initiative sponsored by the Wisconsin Health Information Organization (WHIO), brings together healthcare professionals from across the healthcare spectrum to develop pilot programs designed to address specific healthcare needs. Programs will provide superior healthcare at affordable costs.PHPR partners recognize that a collaborative approach to healthcare payment reform allows for the alignment of incentives among payers, maximizes purchasing strategies, allows for shared learning and analysis, and builds on Wisconsin's healthcare assets and commitment to quality.
The Partnership for Healthcare Payment Reform (PHPR) has developed pilot programs to encourage and reward quality healthcare, while implementing meaningful payment reform.
Karen shares some of the questions she's frequently asked about her experience developing these pilot payment programs. Here is the second chapter in a three-part series on the lessons learned from Wisconsin experiments.
Lessons LearnedDescribe the outcomes, value, results, impact of this project.
There is no question that payment systems are among the leverage points for improving value in healthcare. Although our pilots are in the very early stages of "go live, " we have received positive feedback from participants so far. Participants report that these pilots have catalyzed new conversations with all aspects of the healthcare value stream (provider, payer, patient, employer, suppliers). Several sites are using the pilot to aggressively redesign care processes and are confident they will improve patient safety while reducing costs. Participants report their preference for experimenting on a relatively small scale before tackling more comprehensive payment reform, while also reporting emerging thinking about expanding the scope of these projects. Some payers report that the existence of the PHPR pilots has catalyzed more openness to payment reform even among organizations not participating in the pilots.
What are some key lessons learned so far?
We were surprised by the great difficulty many participants have had in manipulating their data to arrive at a common, trusted baseline of cost for the episode or bundle definition in question. We have been pleasantly surprised at the potential to realize faster progress when participants come to the conversation with a history of trust and an expectation of moving forward together.
How did patients, staff, or other affected parties react to the new program?
Reactions have been mixed; some providers are excited by the project while others are "hoping it will go away." Some payers have incorporated these payment reform experiments into their regular contract negotiation and business processes, while others are struggling to determine whether it is "worth it" to devote extra resources to small pilots. Employers are supportive but looking for faster progress and greater impact. Patients are reported to be focused on maintaining current relationships with their providers and are pleased in the cases where the pilot has resulted in in more predictability of their out-of-pocket expenses.
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