JAN. 28, 2015……Partners Healthcare, the Bay State’s largest private sector employer, plans to substantially decrease its fee-for-service business and boost alternative payment models over the next five years as it announced plans Wednesday to join a national effort aimed at “improving outcomes and lowering costs” in health care.
Currently about half of Partners’ primary care business is under the fee-for-service model, and by 2020 the organization plans to reduce that figure to 25 percent with the other 75 percent in some form of “value-based” payment model. The primary care business does not include referrals or emergency room visits, according to Partners.
Partners is also joining a new organization that includes other providers, as well as insurers, businesses, academics and a patient group that plans to work on recommendations to improve health care delivery.
The Health Care Transformation Task Force is led by Dr. Richard Gilfillan, CEO of Trinity Health, a provider organization based in Livonia, Michigan.
“The recommendations will be in several areas,” Dr. Tim Ferris, Partners senior vice president for population health management, told the News Service.
Ferris predicted the task force will grow and said the idea for it was first raised a little more than a year ago, and there have been a few meetings of the founding group.
On Wednesday the group released its first recommendation on how to design “the next generation” of accountable care organizations.
Some stakeholders within the health care industry are seeking to move away from the fee-for-service model toward schemes where the provider is paid a lump sum for treating a patient. Under the new models, hospitals can be put on the hook if costs grow beyond expected and those same providers can join in the savings if the treatment is provided more efficiently.
“It’s got to be done carefully and there’s a lot of details that we need to iron out,” Ferris said. He said recommendations will likely be in the area of how to create a shared savings program and how to calculate a payment “per episode.”
Blue Cross Blue Shield of Massachusetts has also joined the task force as has Caesars Entertainment and the National Partnership for Women and Families.
Ferris said so far there has been both agreement and sticking points among the members, and he said he hopes some of the recommendations will be adopted by major government organizations, such as the Centers for Medicare and Medicaid Services.
Because of the 2012 Massachusetts health reform law, Ferris said, there is “more pressure here than elsewhere in the country” to lower health care costs. Ferris said a reduction in the size of Partners is “not a necessary outcome of value-based payments.”
Ferris said Partners is interested in taking a greater stake in patient health through the new payment arrangements.
“The fee-for-service system actually constrains us,” Ferris said, saying that the older model “locks” the hospital group into “a set of behaviors” that aren’t always aligned with the interests of patients.
Copyright 2015 State House News Service