Across the United States, fundamental changes are taking place in how health care is delivered and paid for. One of these is a shift away from independent fee-for-service practices to newer models such as medical homes, accountable care organizations, and bundled payment systems that create financial incentives for providers to work together to deliver well-coordinated, high-quality, and cost-effective care. For these new initiatives to be successful, they must contract and collaborate with multiple payers, from private insurers and employers to Medicare and Medicaid. Commonwealth Fund–supported researchers gathered lessons from multipayer medical home initiatives to inform current and future collaborations.
What the Study Found
Researchers from the National Academy for State Health Policy collected data from 17 medical home initiatives launched between 2008 and 2014 involving two or more payers. They looked at how these multipayer programs navigated four critical decision-making areas: convening stakeholders; establishing criteria for provider participation; determining payment; and measuring performance. Although multipayer models are complex and difficult to implement, the researchers gleaned four lessons that can help ensure the success of future initiatives:
- Involve either the state or the federal government—or both—as a convener, payer, or key stakeholder.
- Find common ground between payers and providers on a few key issues where there is already some general agreement—for example, common performance measures.
- When payers are aligned from the start, they are much more likely to collaborate and exert a positive influence on program design.
- Be cognizant that the local insurance market and policy environment are the primary forces shaping implementation.
Medicare’s stepped-up involvement in multipayer initiatives has been a critical turning point. Today, some 1.2 million Medicare beneficiaries are enrolled in multipayer primary care medical homes. This degree of federal support—along with state and local policies that help overcome legal and contractual challenges—is essential for the further advancement of multipayer reform, the authors conclude.