Healthcare organizations will be guided in 2013 by the familiar mantra of IHI’s Triple Aim as well as the emergence of continuum-driven and integrated healthcare delivery systems and the new business and payment models that support them, predicts Steven T. Valentine, president of The Camden Group.
From 2012 into 2013, we see the medical home development as well as specialty co-management agreements that feed into the bundled payments, where we’ve combined the hospital facility fee with the physician fee. Then we see some kind of physician employment, be it a medical foundation or some kind of affiliation partnership with rural health clinics, federally qualified health centers (FQHCs), or community clinics, but delivery system access points. Everyone is moving into one of these models. And in doing so, this is changing payment systems, a trend we expect to continue in 2013, as well as an expansion of co-management agreements within service lines and more patient-centered medical homes. We will also see more physician employment by health systems or larger medical groups.
What is the shape of a co-management agreement? It’s really a partnership of the physicians in that service line with the hospital to truly co-manage a service line. Organizations should put performance metrics in place to measure their ability to reduce expense, improve quality and improve patient satisfaction such that the doctors are economically incentivized to utilize the service, manage the cost and improve the quality of the service. This is a pretty common structure that you would find among organizations that have submitted applications through Medicare for their bundled payment programs. We would expect that, following 2013, many Medicaid systems are going to start to look at bundling some payments.
If we do look at the common elements of payment reform, many of these trends — bundled payment, patient-centered medical home, co-management agreement, clinical integration, and accountable care — are all going to happen due to the economics of healthcare. We will see the accountable care organization in the center, wrapped around with the entire continuum of care. We see the physicians sitting on top of this structure in terms of their ability to influence the spend of money.
Healthcare Trends & Forecasts in 2013: Performance Expectations for the Healthcare Industry HIN’s eagerly anticipated ninth annual industry forecast provides sector-specific guidance for the next 12 months from three key thought leaders.