Brainstorming Themes Regarding Payment Discussed at the 2016 Starfield Summit
| Themes of Starfield Summit Participants' Discussion on Payment | Representative Statements Reflecting Theme |
|---|---|
| There is currently no streamlined, organized system of payment for healthcare. | • Working with eighty different payers is difficult on a practice. |
| • Different payment models serve to fragment our work by turning each aspect of healthcare into a separate transaction. | |
| Barriers and silos hamper innovative payment models. | • The problem of a reductionist, disease-centered paradigm affects specialties as well as primary care. |
| • We need to redefine the buckets of how we pay for social services and healthcare, with no walls between the issues that drive health, including upstream causes. | |
| • It is hard to innovate within regulatory environments that narrowly define healthcare. | |
| Payment models must support, and be supported by, appropriate data measurement, data collection, and delivery infrastructure. | • How do we know when primary care is doing a good job? |
| • We need good evidence on what makes a difference for the health of patients and populations. | |
| • We need payment models that support implementation of new effective services. | |
| Effective payment for primary care would pay for accessibility, comprehensiveness, continuity, and coordination. | • Payment needs to honor the patient-provider relationship…and be structured around ways providers can be held accountable. |
| • How we define primary care is currently the sum of our fee-for-service diagnosis codes. | |
| • Primary care needs to take accountability for population health and advocate for a payment system that reflects this. | |
| Payment needs to be flexible so that clinics, teams, and health systems can use global payments to meet patients in innovative ways and address population health. | • The population health aspect of the triple aim lies almost entirely outside of the health system as it currently exists. |
| • Mandated investments in primary care in Rhode Island shows you can bend the cost curve with a global per-member-per-month flexible payment on a large scale. | |
| An effective payment system needs to be risk-adjusted on the population level, rather than individual patients. | • Risk adjustment is necessary to prevent further marginalization of vulnerable populations. |
| Budgets for primary care need to include interventions that address the social determinants of health. | • Social determinants of health are not just things that poor people face, they are a problem for everyone. |
| • Why is there not time for pro-active case management by clinicians? | |
| • Need to address all the things that our patient's struggle with to create health. |