Catalyst for Payment Reform
Advancing Primary Care
April 24, 2015
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These Catalyst for Payment Reform scorecards, supported by NYSHealth, provide a detailed look into how health care is being paid for in New York State and the types of value-oriented arrangements that are being used.
The scorecards are the first in the nation to use comprehensive and fully representative data for the commercial market and the first ever to evaluate payment arrangements in the Medicaid market.
Health care payments are moving away from a fee-for-service paradigm to alternative payments that emphasize value. New York State has set ambitious goals to have large majorities of patients in both Medicaid and the commercial market receiving care under some form of value-based payment in the coming years.
But what do health care payments look like in New York State today? What baseline are we starting from and how can we evaluate progress toward these goals? Do commercial and Medicaid payments look similar or different?
The New York Scorecard on Commercial Payment Reform finds that 34% of all commercial in-network payments are value-oriented—either tied to performance or designed to cut waste. Traditional fee-for-service (FFS), bundled, capitated, and partially capitated payments without quality incentives make up the remaining 66%. FFS remains the dominant base method of payments to providers (94% of all commercial in-network payments made in New York). In the commercial sector, the most common form of value-oriented payment is pay-for-performance (23%), which is typically a traditional FFS payment with a bonus for meeting quality or efficiency goals.
The New York Scorecard on Medicaid Payment Reform shows that 33% of all Medicaid payments are value-oriented, whereas 67% remain traditional FFS, bundled, capitated, and partially capitated payments without quality incentives. The majority of Medicaid payments (nearly 73%) are still based on FFS, and nearly 56% of FFS payments still do not include any quality components. In Medicaid, the most common form of payment reform is a combination of non-FFS base payments with a shared savings agreement (13%).
NYSHealth hosted a briefing, “Tracking New York’s Progress on Payment Reform,” on April 30, 2015, to present the scorecards’ findings. Senior New York State officials and an expert panel of reactors participated in the briefing and offered their perspectives on payment reform. Watch a video of the briefing.
Watch a video on Capital Tonight where NYSHealth Senior Vice President David Sandman talks about value-based payments in New York and the first-ever scorecard on payment reform in New York State, developed by Catalyst for Payment Reform with support from NYSHealth.