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>>  1.1 Medicare's Sustainable Growth Rate (SGR)

  • BIPARTISAN POLICY COUNCIL
    Promote quality and value through an improved, enrollment-based version of accountable care organizations (ACOs) called "Medicare Networks," formed and governed by providers. Read More >>
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  • BROOKINGS INSTITUTION
    Eliminate SGR and transition from FFS-based system to Medicare Comprehensive Care (MCC). Read More >>
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  • CENTER FOR AMERICAN PROGRESS
    Repeal and reform the SGR mechanism. Read More >>
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  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Repeal and replace the SGR with a Medicare physician payment policy that provides incentives to improve health outcomes and participate in care system innovation. Read More >>
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  • MOMENT OF TRUTH PROJECT
    Reform the SGR to move Medicare physician payment away from FFS to a system that encourages coordinated care and quality; in the short-term, impose a modest reduction in reimbursement rates below a freeze and allow the Centers for Medicare & Medicaid Services (CMS) to make certain budget-neutral adjustments aimed at improving care quality. [page 19] [Medicare] Read More >>
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  • NATIONAL COALITION ON HEALTH CARE
    Eliminate the SGR formula and move from fee-for-service payment toward pay-for-value. Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Transition away from SGR and toward value-based systems of health care delivery and provider reimbursement (including patient safety initiatives, patient-centered medical homes, ACOs, episodic bundling and global payments, and value-based payment updates to Medicare's fee schedule). [page 12] [Medicare]
>>  1.2 Medicare Payment Rates

  • BIPARTISAN POLICY COUNCIL
    Promote quality and value through an improved, enrollment-based version of accountable care organizations (ACOs) called "Medicare Networks," formed and governed by providers. Read More >>
  •  
  • BROOKINGS INSTITUTION
    Eliminate SGR and transition from FFS-based system to Medicare Comprehensive Care (MCC). Read More >>
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  • CENTER FOR AMERICAN PROGRESS
    Use competitive bidding for all health care products: (1) expand competitive bidding by 2014 for durable medical equipment, prosthetics, orthotics, and supplies nationwide; (2) extend competitive bidding by 2015 to medical devices, lab tests, advanced imagine services, and all other health care products; (3) extend competitively bid prices to Medicaid and all other government health programs. [page 4] [Medicare, Medicaid] Read More >>
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  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Repeal and replace the SGR with a Medicare physician payment policy that provides incentives to improve health outcomes and participate in care system innovation. Read More >>
  •  
  • NATIONAL COALITION ON HEALTH CARE
    Eliminate the SGR formula and move from FFS payment toward pay-for-value. Read More >>
  •  
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Accelerate efforts by private payers and Medicare to provide incentives to physicians and hospitals for meeting performance benchmarks compared to their peers, while accounting for case mix and socioeconomic status of their underlying populations; include benchmarks that continually drive improvement. [page 5] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • BROOKINGS INSTITUTION
    Use common performance measures and the MCC payment reforms to create a more straightforward pathway for Medicare to join in state-based financing reforms that have a "critical mass" of participants in a state including private plans, state/employee retiree plans, and Medicaid plans. [page 32] [Medicare, Medicaid, Private Payers, FEHBP]
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  • CENTER FOR AMERICAN PROGRESS
    Use competitive bidding for all health care products: (1) expand competitive bidding by 2014 for durable medical equipment, prosthetics, orthotics, and supplies nationwide; (2) extend competitive bidding by 2015 to medical devices, lab tests, advanced imagine services, and all other health care products; (3) extend competitively bid prices to Medicaid and all other government health programs. [page 4] [Medicare, Medicaid] Read More >>
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  • NATIONAL COALITION ON HEALTH CARE
    Implement MedPAC's recommendations for expansion of the Program for All-Inclusive Care for the Elderly (PACE). Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Accelerate efforts by private payers and Medicare to provide incentives to physicians and hospitals for meeting performance benchmarks compared to their peers, while accounting for case mix and socioeconomic status of their underlying populations; include benchmarks that continually drive improvement. [page 5] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • BIPARTISAN POLICY COUNCIL
    Supplemental Coverage: To lower costs for Medicare beneficiaries and encourage more appropriate utilization of care, beginning in 2016, all supplemental coverage from Medigap plans and employer-provided plans (including TRICARE for Life and the Federal Employees Health Benefits [FEHB] Program) should: (1) Include a deductible of at least $250; (2) include a beneficiary out-of-pocket maximum no lower than $2,500 ; and (3) cover no more than half of beneficiary copayments and coinsurance. [pages 54-56] [Medicare, Private Payers, FEHBP]
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  • BROOKINGS INSTITUTION
    Use common performance measures and the MCC payment reforms to create a more straightforward pathway for Medicare to join in state-based financing reforms that have a "critical mass" of participants in a state including private plans, state/employee retiree plans, and Medicaid plans. [page 32] [Medicare, Medicaid, Private Payers, FEHBP]
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Accelerate efforts by private payers and Medicare to provide incentives to physicians and hospitals for meeting performance benchmarks compared to their peers, while accounting for case mix and socioeconomic status of their underlying populations; include benchmarks that continually drive improvement. [page 5] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • BIPARTISAN POLICY COUNCIL
    Supplemental Coverage: To lower costs for Medicare beneficiaries and encourage more appropriate utilization of care, beginning in 2016, all supplemental coverage from Medigap plans and employer-provided plans (including TRICARE for Life and the Federal Employees Health Benefits [FEHB] Program) should: (1) Include a deductible of at least $250; (2) include a beneficiary out-of-pocket maximum no lower than $2,500; and (3) cover no more than half of beneficiary copayments and coinsurance. [pages 54-56] [Medicare, Private Payers, FEHBP]
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  • BROOKINGS INSTITUTION
    Use common performance measures and the MCC payment reforms to create a more straightforward pathway for Medicare to join in state-based financing reforms that have a "critical mass" of participants in a state including private plans, state/employee retiree plans, and Medicaid plans. [page 32] [Medicare, Medicaid, Private Payers, FEHBP]
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Accelerate efforts by private payers and Medicare to provide incentives to physicians and hospitals for meeting performance benchmarks compared to their peers, while accounting for case mix and socioeconomic status of their underlying populations; include benchmarks that continually drive improvement. [page 5] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
>>  1.3 Strengthen and Expand Value-Based Purchasing
  • BIPARTISAN POLICY COUNCIL
    Promote quality and value through an improved, enrollment-based version of accountable care organizations (ACOs) called "Medicare Networks," formed and governed by providers. Read More >>
  •  
  • BROOKINGS INSTITUTION
    Eliminate sustainable growth rate (SGR) and transition from fee-for-service-based system to Medicare Comprehensive Care (MCC). Read More >>
  •  
  • CENTER FOR AMERICAN PROGRESS
    Medicare and Medicaid should accelerate use of alternatives to FFS payment. Read More >>
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  • NATIONAL COALITION ON HEALTH CARE
    Eliminate the SGR and move from FFS payment toward pay-for-value. Read More >>
  •  
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Develop robust quality metrics that are designed to gauge progress in achieving the goal of value-based payment models. Read More >>
  • BROOKINGS INSTITUTION
    Use common performance measures and the MCC payment reforms to create a more straightforward pathway for Medicare to join in state-based financing reforms that have a "critical mass" of participants in a state including private plans, state/employee retiree plans, and Medicaid plans. [page 32] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
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  • CENTER FOR AMERICAN PROGRESS
    By 2014, require all Medicaid managed care programs to use competitive bidding. Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Develop robust quality metrics that are designed to gauge progress in achieving the goal of value-based payment models. Read More >>
  • BROOKINGS INSTITUTION
    Support employer efforts to engage employees in reducing overall health care costs by ensuring that Employee Retirement Income Security Act (ERISA) and other regulations do not hinder value-based insurance designs (VBIDs), tiered benefit designs, and employees' ability to share in health savings. Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Develop robust quality metrics that are designed to gauge progress in achieving the goal of value-based payment models. Read More >>
  • BROOKINGS INSTITUTION
    Use common performance measures and the MCC payment reforms to create a more straightforward pathway for Medicare to join in state-based financing reforms that have a "critical mass" of participants in a state including private plans, state/employee retiree plans, and Medicaid plans. [page 32] [Medicare, Medicaid, Private Payers, FEHBP]
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  • CENTER FOR AMERICAN PROGRESS
    Improve the Federal Employees Health Benefits (FEHB) Program and use it to reform health care delivery. FEHB should align with Medicare on payment reforms, metrics, and value-based purchasing. [page 11] [FEHBP]
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Develop robust quality metrics that are designed to gauge progress in achieving the goal of value-based payment models. Read More >>
>>  1.4 Expand Bundled Payment Approaches and Other Alternatives to Fee-for-Service Payment


  • BIPARTISAN POLICY COUNCIL
    Promote quality and value through an improved, enrollment-based version of accountable care organizations (ACOs) called "Medicare Networks," formed and governed by providers. Read More >>
  •  
  • BROOKINGS INSTITUTION
    Eliminate SGR and transition from FFS-based system to Medicare Comprehensive Care (MCC). Read More >>
  •  
  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  •  
  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Repeal and replace the SGR with a Medicare physician payment policy that provides incentives to improve health outcomes and participate in care system innovation. Read More >>
  •  
  • MOMENT OF TRUTH PROJECT
    Establish a system where many providers are paid a fixed amount for a bundle of services or all of a patient's care; expand the Medicare Acute Care Episode (ACE) Demonstration program, and pay more and more providers under this type of model over time. [page 20] [Medicare]
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  • NATIONAL COALITION ON HEALTH CARE
    Expand participation in CMS demonstrations and pilots by allowing rolling applications from providers. Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Within Medicare, adopt bundled payments for select conditions and procedures that encompass a set of well-defined services and have a relatively clear beginning and end point. [page 8] [Medicare] Read More >>
  • BROOKINGS INSTITUTION
    Implement a standard program for person-focused Medicaid that includes support for capitated Medicaid managed care organizations, as well as state-directed reforms that focus on particular components of care. Read More >>
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  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
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  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Accelerate bundled payment approaches for hospital and post-acute care under Medicare, Medicaid, other public programs (including the Federal Employees Health Benefits Program), and private plans participating in insurance exchanges; such bundled payments should support movement toward high performance and provide incentives for hospitals to make transitions and follow-up care a priority. [page 24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
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  • NATIONAL COALITION ON HEALTH CARE
    CMS should insist on key beneficiary protections for the dually eligible throughout the implementation of state demonstrations. Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Broadly implement Medicare pilots that use bundled payments for acute hospitalization and post-hospitalization services, including bundled payments for post-acute care, follow-up physician services, and readmissions within a defined period following discharge (for example, 30/60/90 days); further expand these bundles through collaboration and alignment with the private sector. [page 8] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • BROOKINGS INSTITUTION
    Support employer efforts to engage employees in reducing overall health care costs by ensuring that ERISA and other regulations do not hinder value-based insurance designs, tiered benefit designs, and employees' ability to share in health savings. Provide employers with standard measures of provider performance. [p. 27) [Private Payers]
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  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  •  
  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Accelerate bundled payment approaches for hospital and post-acute care under Medicare, Medicaid, other public programs (including the Federal Employees Health Benefits Program), and private plans participating in insurance exchanges; such bundled payments should support movement toward high performance and provide incentives for hospitals to make transitions and follow-up care a priority. [page 24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Broadly implement Medicare pilots that use bundled payments for acute hospitalization and post-hospitalization services, including bundled payments for post-acute care, follow-up physician services, and readmissions within a defined period following discharge (for example, 30/60/90 days); further expand these bundles through collaboration and alignment with the private sector. [page 8] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  •  
  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Accelerate bundled payment approaches for hospital and post-acute care under Medicare, Medicaid, other public programs (including the Federal Employees Health Benefits Program), and private plans participating in insurance exchanges; such bundled payments should support movement toward high performance and provide incentives for hospitals to make transitions and follow-up care a priority. [page 24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Broadly implement Medicare pilots that use bundled payments for acute hospitalization and post-hospitalization services, including bundled payments for post-acute care, follow-up physician services, and readmissions within a defined period following discharge (for example, 30/60/90 days); further expand these bundles through collaboration and alignment with the private sector. [page 8] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
>>  1.5 Medicare Advantage

  • BIPARTISAN POLICY COUNCIL
    Establish a standardized minimum benefit for Medicare Advantage (MA) plans—including all services covered by traditional Medicare, a cost-sharing limit to protect against catastrophic expenses, and slightly lower cost-sharing—and pay plans using a competitive pricing system. Read More >>
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  • BROOKINGS INSTITUTION
    Require that MA per capita payment increase match that of Medicare Comprehensive Care (MCC) plans (GDP + 0%), or less if Medicare costs grow more slowly. [pages 20-21] [Medicare] Read More >>
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  • CENTER FOR AMERICAN PROGRESS
    Use competitive bidding for MA by basing the benchmark for private plans on their average bid by 2014. [page 6] [Medicare] Read More >>
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  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    With a "Medicare Essential" plan (a new Medicare option that provides more integrated, comprehensive benefits and better protection against catastrophic costs) in place, recalibrate MA plan payments based on the costs of a new Medicare Essential option; offer high-quality, low-cost MA plans and their enrollees shared savings to encourage plans to operate more efficiently and encourage beneficiaries to select the best plan for them. [page 27] [Medicare]
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  • MOMENT OF TRUTH PROJECT
    Consider making MA payments based on a "competitive bidding" system rather than a fixed rate, but only if such a system can be designed in a way that reduces costs without damaging quality. [page 20] [Medicare]
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  • NATIONAL COALITION ON HEALTH CARE
    Implement the Medicare Payment Advisory Committee's (MedPAC) recommendation to empower the U.S. Secretary of Health and Human Services to vary cost-sharing based on evidence of a particular treatment's effectiveness. Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Disseminate best practices for global payment models, including those from MA and Medicaid managed care, to further support movement to global payments, including alignment of quality measures across the public and private sectors. [page 11] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    - Disseminate best practices for global payment models, including those from MA and Medicaid managed care, to further support movement to global payments, including alignment of quality measures across the public and private sectors. [page 11] [Medicare, Medicaid, Private Payers, FEHBP]
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    - Disseminate best practices for global payment models, including those from MA and Medicaid managed care, to further support movement to global payments, including alignment of quality measures across the public and private sectors. [page 11] [Medicare, Medicaid, Private Payers, FEHBP]
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    - Disseminate best practices for global payment models, including those from MA and Medicaid managed care, to further support movement to global payments, including alignment of quality measures across the public and private sectors. [page 11] [Medicare, Medicaid, Private Payers, FEHBP]
>>  1.6 Supporting Primary Care
  • CENTER FOR AMERICAN PROGRESS
    Better coordinate care for beneficiaries eligible for both Medicare and Medicaid. Medicaid should allow all dual eligibles to choose a primary care medical home to coordinate all care. Read More >>
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  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Change payment of primary care to reward care management, coordination, and a team-based systemic approach to caring for patients under Medicare, Medicaid, other public programs, and private plans participating in health insurance exchanges. [pages 23-24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
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  • MOMENT OF TRUTH PROJECT
    Direct CMS to develop an improved physician-payment formula for the Medicare program that promotes participation in new models (such as accountable care organizations [ACOs] and patient-centered medical homes), encourages care coordination across multiple providers, prioritizes primary care, and reduces Medicare costs. This would be enforced by the potential to reinstate a rebased sustainable growth rate (SGR) if a new formula is not implemented. [page 19] [Medicare]
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  • NATIONAL COALITION ON HEALTH CARE
    Eliminate the SGR formula and move from fee-for-service (FFS) payment toward pay-for-value. Read More >>
  •  
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Expand Medicare, Medicaid, and private patient-centered medical home pilots to include more patients and providers. [page 7] [Medicare, Medicaid, Private Payers] Read More >>
  • BROOKINGS INSTITUTION
    Implement a standard program for person-focused Medicaid that includes support for capitated Medicaid managed care organizations as well as state-directed reforms that focus on particular components of care. Read More >>
  •  
  • CENTER FOR AMERICAN PROGRESS
    Better coordinate care for beneficiaries eligible for both Medicare and Medicaid. Medicaid should allow all dual eligibles to choose a primary care medical home to coordinate all care. Read More >>
  •  
  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Change payment of primary care to reward care management, coordination, and a team-based systemic approach to caring for patients under Medicare, Medicaid, other public programs, and private plans participating in health insurance exchanges. [pages 23-24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  •  
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Expand Medicare, Medicaid, and private patient-centered medical home pilots to include more patients and providers. [page 7] [Medicare, Medicaid, Private Payers] Read More >>
  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Change payment of primary care to reward care management, coordination, and a team-based systemic approach to caring for patients under Medicare, Medicaid, other public programs, and private plans participating in health insurance exchanges. [pages 23-24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Expand Medicare, Medicaid, and private patient-centered medical home pilots to include more patients and providers. [page 7] [Medicare, Medicaid, Private Payers] Read More >>
  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Change payment of primary care to reward care management, coordination, and a team-based systemic approach to caring for patients under Medicare, Medicaid, other public programs, and private plans participating in health insurance exchanges. [pages 23-24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Increase the proportion of medical home payments that are contingent on achieving quality goals, moving to a system that rewards providers for meeting quality and cost goals over time, and, finally to a model, if appropriate, that provides a single capitated payment for a patient's primary care. [page 7] [Medicare, Medicaid, Private Payers, FEHBP]
>>  1.7 Establish Provider Incentives to Promote High-Quality Care


  • BIPARTISAN POLICY COUNCIL
    Promote quality and value through an improved, enrollment-based version of accountable care organizations (ACOs) called "Medicare Networks," formed and governed by providers. Read More >>
  •  
  • BROOKINGS INSTITUTION
    Eliminate SGR and transition from FFS-based system to Medicare Comprehensive Care (MCC). Read More >>
  •  
  • CENTER FOR AMERICAN PROGRESS
    Medicare and Medicaid should accelerate use of alternatives to FFS payment. Read More >>
  •  
  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Create new payment incentives and support for comprehensive primary care teams that focus on the highest-cost Medicare and Medicaid patients; extend incentives to the Federal Employees Health Benefits (FEHB) Program, the military health coverage programs (TRICARE and the Civilian Health and Medical Program of the Uniformed Services), the Veterans Health Administration, and other federal programs. [page 24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
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  • MOMENT OF TRUTH PROJECT
    Expand penalties for unnecessary hospital readmissions and avoidable complications ("never events"); expand the Hospital Readmissions Reduction Program to include more medical conditions and higher penalties on more types of providers. Work to calibrate penalties to adjust for patient demographics, types of condition, and timing of readmission. [pages 19-20] [Medicare]
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  • NATIONAL COALITION ON HEALTH CARE
    Apply immediate payment incentives for participation in quality and value incentives to the existing FFS pay schedule. Read More >>
  •  
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Accelerate efforts by private payers and Medicare to provide incentives to physicians and hospitals for meeting performance benchmarks compared to their peers, while accounting for case mix and socioeconomic status of their underlying populations; include benchmarks that continually drive improvement. [page 5] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • BROOKINGS INSTITUTION
    Implement a standard program for "Person-Focused Medicaid" that includes support for capitated Medicaid managed care organizations as well as state-directed reforms that focus on particular components of care. Read More >>
  •  
  • CENTER FOR AMERICAN PROGRESS
    By 2014, require all Medicaid managed care programs to use competitive bidding. Read More >>
  •  
  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Create new payment incentives and support for comprehensive primary care teams that focus on the highest-cost Medicare and Medicaid patients; extend incentives to the Federal Employees Health Benefits (FEHB) Program, the military health coverage programs (TRICARE and the Civilian Health and Medical Program of the Uniformed Services), the Veterans Health Administration, and other federal programs. [page 24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  •  
  • NATIONAL COALITION ON HEALTH CARE
    Implement MedPAC's recommendations for expansion of the Program for All-Inclusive Care for the Elderly (PACE). Read More >>
  •  
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Accelerate efforts by private payers and Medicare to provide incentives to physicians and hospitals for meeting performance benchmarks compared to their peers, while accounting for case mix and socioeconomic status of their underlying populations; include benchmarks that continually drive improvement. [page 5] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • BROOKINGS INSTITUTION
    Implement regulations for the insurance marketplaces that allow actuarially equivalent benefit designs combined with flexibility in plan choices to promote innovation in value, combined with quality reporting. [page 27] [Private Payers]
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  • CENTER FOR AMERICAN PROGRESS
    Require health insurance exchanges and state employee plans to offer tiered insurance plans that designate providers with high quality and low costs for patients (at least one tiered product at the bronze and silver levels by 2016). Read More >>
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  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Create new payment incentives and support for comprehensive primary care teams that focus on the highest-cost Medicare and Medicaid patients; extend incentives to the Federal Employees Health Benefits (FEHB) Program, the military health coverage programs (TRICARE and the Civilian Health and Medical Program of the Uniformed Services), the Veterans Health Administration, and other federal programs. [page 24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Accelerate efforts by private payers and Medicare to provide incentives to physicians and hospitals for meeting performance benchmarks compared to their peers, while accounting for case mix and socioeconomic status of their underlying populations; include benchmarks that continually drive improvement. [page 5] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  •  
  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Create new payment incentives and support for comprehensive primary care teams that focus on the highest-cost Medicare and Medicaid patients; extend incentives to the Federal Employees Health Benefits (FEHB) Program, the military health coverage programs (TRICARE and the Civilian Health and Medical Program of the Uniformed Services), the Veterans Health Administration, and other federal programs. [page 24] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  •  
  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Accelerate efforts by private payers and Medicare to provide incentives to physicians and hospitals for meeting performance benchmarks compared to their peers, while accounting for case mix and socioeconomic status of their underlying populations; include benchmarks that continually drive improvement. [page 5] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
>>  1.8 Adjust Prescription Drug Reimbursement and Pricing
  • BIPARTISAN POLICY COUNCIL
    Require all Medicare Advantage plans to include Part D prescription drug coverage by 2015. [page 45] [Medicare] Read More >>
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  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
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  • MOMENT OF TRUTH PROJECT
    Restore drug rebates for those on Medicaid by requiring them for dual eligibles who receive drug coverage through Medicare Part D; require manufacturers of these drugs to be responsible for the same 23.1 percent above average manufacturer price (AMP) rebate as in Medicaid, with the same additional rebate for price increases that exceeded the rate of inflation. [page 27] [Medicare, Medicaid]
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  • NATIONAL COALITION ON HEALTH CARE
    Reform Medicare Part B reimbursement for provider-administered medications. Read More >>
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  • PARTNERSHIP FOR SUSTAINABLE HEALTH CARE
    Use comparative evidence to set reimbursement rates at the time of coverage. Read More >>
  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  •  
  • MOMENT OF TRUTH PROJECT
    Restore drug rebates for those on Medicaid by requiring them for dual eligibles who receive drug coverage through Medicare Part D; require manufacturers of these drugs to be responsible for the same 23.1 percent above average manufacturer price (AMP) rebate as in Medicaid, with the same additional rebate for price increases that exceeded the rate of inflation. [page 27] [Medicare, Medicaid]
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  • NATIONAL COALITION ON HEALTH CARE
    Incentivize state governments to increase generic drug utilization in Medicaid by allowing states to share in the savings generated when generic substitution increases. An appeals process should be established for those patients for whom the difference between generic and brand-name drugs is clinically significant. [page 22] [Medicaid]
  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
>>  1.9 Realign Graduate Medical Education Payments
  • BIPARTISAN POLICY COUNCIL
    Graduate Medical Education (GME): Reduce the indirect medical education (IME) percentage add-on to inpatient hospital admissions from 5.5 percent to 3.5 percent. Read More >>
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  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
  • CENTER FOR AMERICAN PROGRESS
    Form "accountable care states" with global targets for all health care spending by both public and private payers. Read More >>
>>  1.10 Other Payment Reforms


  • BIPARTISAN POLICY COUNCIL
    Medicare Advantage: Implement a reinsurance system for Medicare Advantage (MA) by 2016, similar to system in place for Medicare Part D. [page 45] [Medicare]
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  • BROOKINGS INSTITUTION
    Use common performance measures and the MCC payment reforms to create a more straightforward pathway for Medicare to join in state-based financing reforms that have a "critical mass" of participants in a state including private plans, state/employee retiree plans, and Medicaid plans. [p. 32] [Medicare, Medicaid, Private]
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  • CENTER FOR AMERICAN PROGRESS
    Expand Medicare and Medicaid's ban on physician self-referrals by closing loopholes for in-office imaging, pathology laboratories, and radiation therapy (exception should apply to physicians who use alternatives to FFS payment). Read More >>
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  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Accelerate payment policy innovations across federal and state public programs to stimulate change across the country and support local care system innovation. [page 25] [Medicare, Medicaid] Read More >>
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  • MOMENT OF TRUTH PROJECT
    Give the Independent Payment Advisory Board (IPAB) expanded authority to change benefit design and reform cost-sharing rules and prevent IPAB from being restricted through special interest carve-outs. [page 21] [Medicare] Read More >>
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  • NATIONAL COALITION ON HEALTH CARE
    Require Medicare to cover participation in the Diabetes Prevention Program (DPP) for eligible people with prediabetes. Read More >>
  • BIPARTISAN POLICY COUNCIL
    Under the Center for Medicare and Medicaid Innovation, test alternative models of federally qualified health center (FQHC) reimbursement to assure quality and value in the Medicaid program, monitoring quality and ensuring that reductions in Medicaid payments do not shift costs inappropriately. [page 102] [Medicaid]
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  • BROOKINGS INSTITUTION
    Use common performance measures and the MCC payment reforms to create a more straightforward pathway for Medicare to join in state-based financing reforms that have a "critical mass" of participants in a state including private plans, state/employee retiree plans, and Medicaid plans. [p. 32] [Medicare, Medicaid, Private]
  •  
  • CENTER FOR AMERICAN PROGRESS
    Expand Medicare and Medicaid's ban on physician self-referrals by closing loopholes for in-office imaging, pathology laboratories, and radiation therapy (exception should apply to physicians who use alternatives to FFS payment). Read More >>
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  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Accelerate payment policy innovations across federal and state public programs to stimulate change across the country and support local care system innovation. [page 25] [Medicare, Medicaid]
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  • MOMENT OF TRUTH PROJECT
    Gradually close the loophole whereby states finance a portion of their Medicaid spending by imposing taxes on the same health care providers who are paid by the Medicaid program, increasing payments to those providers by the same amount as the tax, and then using that additional "spending" to increase their federal match. [page 28] [Medicaid] Read More >>
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  • NATIONAL COALITION ON HEALTH CARE
    Support behavioral health homes by providing community mental health centers and other behavioral health providers access to meaningful use incentive payments for adopting qualifying health information technology systems. [page 30] [Medicare, Medicaid]
  • BROOKINGS INSTITUTION
    Use common performance measures and the MCC payment reforms to create a more straightforward pathway for Medicare to join in state-based financing reforms that have a "critical mass" of participants in a state including private plans, state/employee retiree plans, and Medicaid plans. [p. 32] [Medicare, Medicaid, Private]
  •  
  • CENTER FOR AMERICAN PROGRESS
    Expand Medicare and Medicaid's ban on physician self-referrals by closing loopholes for in-office imaging, pathology laboratories, and radiation therapy (exception should apply to physicians who use alternatives to FFS payment). The Stark Law should be expanded to prohibit physician self-referrals for services that are paid for by private insurers. [page 13] [Medicare, Medicaid, Private Payers]
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  • THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM
    Encourage private plans in each state to negotiate prices consistent with efficient care and value and not to just pass on higher prices to consumers. [page 25] [Private Payers] Read More >>
Source: Katie Horton, J.D., M.P.H., R.N., Mary-Beth Malcarney, J.D., M.P.H., and Naomi Seiler J.D., George Washington University Department of Health Policy.