jennifer dixon: reforming payment for health care in europe to achieve better value
TRANSCRIPT
Reforming payment for health care in Europe to achieve better value Dr Jennifer Dixon
Director
www.nuffieldtrust.org.uk
Overall trends Bundled payment Pay for performance Value based contracting for LTC Some questions
Objectives of payment reforms
• Extract more quality
• Extract more efficiency
• Preserve equity
Providers
Command’ (Target, directive, guidance)
Financial incentives
Regulation Accountability
Payment currency Price level Competition and choice
Context
Two broad types of payment
Pay
for p
erfo
rman
ce
Bundling
High
Low
Low High
Overall trends Bundled payment Pay for performance Chronic disease management Some questions
Types of bundled payment
Block budget/salary
Capitation Per period Per patient pathway
Per case/diagnosis/procedure
Per day Fee-for-service
Periodic global lump sum – independent of number of patients
Periodic lump sum per enrolled patient for a range of services
Periodic lump sum per patient diagnosed with a particular condition
Lump sum for all services required for a defined pathway of care
Payment per case based on grouping of patients with similar diagnoses/procedures or resource needs
Payment per day of stay in a hospital or other facility
Payment for each item of service and patient contact
High Low
Source: Adapted from Department of Health 2011. England
Prospective payment per DRGs
• Gradual introduction and extension of DRG payment
• Complexity and cost
• Whether and how best to add on P4P incentives
• ? Harmonisation?
• Impact
Overall trends Bundled payment Pay for performance Value-based contracting Some questions
Some types of pay for performance
Rewarding quality
and/or
Rewarding efficiency
Achievement against absolute threshold
Achievement against relative improvement
Rewarding (positive) Penalising (negative)
Value : a proportion of core funding Value: a supplementary bonus above core funding
Issues in pay for performance
• Type of performance measure used
• Information accuracy/availability (and gaming)
• Who to reward – individuals teams institutions?
• Nationally or locally determined?
• Impact
Overall trends Bundled payment Pay for performance Value-based contracting Some questions
Objectives of payment reforms
• Extract more quality
• Extract more efficiency
• Preserve equity
Focus on chronic disease and frailty
Types of bundled payment
Block budget/salary
Capitation Per period Per patient pathway
Per case/diagnosis/procedure
Per day Fee-for-service
Periodic global lump sum – independent of number of patients
Periodic lump sum per enrolled patient for a range of services
Periodic lump sum per patient diagnosed with a particular condition
Lump sum for all services required for a defined pathway of care
Payment per case based on grouping of patients with similar diagnoses/procedures or resource needs
Payment per day of stay in a hospital or other facility
Payment for each item of service and patient contact
High Low
P4P: Eg shared savings contingent on quality
Types of bundled payment
Block budget/salary
Capitation Per period Per patient pathway
Per case/diagnosis/procedure
Per day Fee-for-service
Periodic global lump sum – independent of number of patients
Periodic lump sum per enrolled patient for a range of services
Periodic lump sum per patient diagnosed with a particular condition
Lump sum for all services required for a defined pathway of care
Payment per case based on grouping of patients with similar diagnoses/procedures or resource needs
Payment per day of stay in a hospital or other facility
Payment for each item of service and patient contact
High Low
P4P: Eg shared savings contingent on quality
DRG + Quality?
The future? Modular payment
GP practices
Community services
Social care
Hospital Payers
Capitation-based £ Risk adjusted +P4P
DRG for elective surgery +P4P
Nuffield Trust
Overall trends Bundled payment Pay for performance Value-based contracting Some questions