Karen Timberlake, director of the Partnership for Healthcare Payment Reform (PHPR) in Wisconsin, shares her insights on implementing new payment reform pilots.
Lessons from the Partnership for Healthcare Payment Reform
Part 1 - Implementing New Payment Reform Models
Contributor: Karen Timberlake, Director, Partnership for Healthcare Payment Reform 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 first chapter in a three-part series on the lessons learned from Wisconsin experiments.
Describe the issue you were trying to solve when you began.
In Wisconsin as in other states, healthcare costs continue to rise at several times the rate of inflation or wages, and growth in costs also considerably outpaces growth in healthcare quality. Although Wisconsin has a deserved reputation for relatively high quality, low cost health care, there is growing consensus that our current rate of cost growth is unsustainable, and that fee for service reimbursement is among the major contributors to this problem. By designing payment reform pilot projects, PHPR seeks to allow healthcare providers and payers in Wisconsin to test alternatives to fee for service reimbursement. PHPR began with a commitment to multi-payer payment reform, on the premise that providers can more easily respond to aligned reimbursement signals from multiple payers. Wisconsin also has a strong tradition of voluntary transparency efforts in healthcare quality and cost (such as the Wisconsin Collaborative for Healthcare Quality and the transparency efforts of the Wisconsin Hospital Association), and there is a commitment to publicly report results of the PHPR pilots.
Describe and explain your progress so far.
PHPR has launched payment reform pilots including a bundled payment for total knee replacement (TKR), and a shared savings project, transitioning to an episode-based payment, for adults with diabetes. Both of these projects are beginning with patients who are between the ages of 18 and 64 and are commercially insured. Two hospitals and one ambulatory surgery center are live with the TKR pilot, and two more hospitals will be live by the fourth quarter of 2012. A large clinically integrated collaboration, comprising two major hospital and health systems, is participating in the diabetes project. In total, these providers will be working with seven commercial insurers.
What were the greatest challenges? How did you overcome these?
As with all payment reform projects, our greatest challenges fall into three main areas: 1) Competition for attention and resources within the participant (and non-participant) organizations. 2) Data, data, data. 3) Identifying and developing appropriate marketplace incentives to support participation. We have overcome some of these challenges and are in the process of overcoming others through continued open dialogue among our participants and a strong commitment to shared learning. Fastest progress has been achieved in those participant organizations that decided to prioritize the pilot, devoted the staff and resources necessary, and adopted an attitude of "the answer to ‘how' is ‘yes'." We also have received valuable technical assistance with practical implementation issues from the Healthcare Incentives Improvement Institute through AF4Q.
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