Sustainable Payment Models to Support Effective Care Management Programs for High-Need, High-Cost Patients


Previous work demonstrates that flexible provider payment models can allow health care organizations to deliver the range of services that so many high-need, high-cost patients require, including behavioral health and social services. This project will build on the efforts of the Health Care Transformation Task Force, whose members-health plans, providers, patients, and purchasers-are committed to pursuing value-based payment arrangements that enable providers to attend to their patients' medical and nonmedical needs. In 2015, the Task Force chartered a work group to advise members on practical steps they can take to improve care for their high-need, high-cost population-including ways to ensure access to social services. The task force also published a white paper on sustainable care models. To accelerate the spread of effective care programs for high-need, high-cost adults, the project team seeks to facilitate the adoption of provider payment systems that will allow such programs, which often include a nonmedical service component, to be sustainable in the long term. The team will interview leaders from 10 organizations that have programs in place meeting the following criteria: 1) evidence of improved health outcomes; 2) business sustainability; and 3) model replicability and relevance. After synthesizing insights about payment models that support the provision of both medical and nonmedical services, the team will produce templates with generalizable contract terms and contracting guidance intended to speed adoption for payers and delivery systems. This project will provide payers and delivery system leaders with the information they need to select and implement value-based payment mechanisms that can sustain effective care models for high-need, high-cost patients.

Grant Details

Grantee Organization:
Pacific Business Group on Health
Principal Investigator:
Diane Stewart, M.B.A.
Award Amount:
Approval Date:
July 11, 2017

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