Value-Based Payment System Pilot: Increased Accountability, Improved Care?

May 7, 2015

The University of Texas MD Anderson Cancer Center in Houston has always been on the cutting edge when it comes to providing high quality care. For the past 25 years, this multi-disciplinary facility has been ranked in the top two cancer centers in the United States, according to U.S. News & World Report’s annual “Best Hospitals” survey.

MDACC_2C_RGB_tagNow, MD Anderson is building on its reputation to break new ground again—piloting a new, bundled payment plan in conjunction with United Healthcare for a select group of patients newly diagnosed with head and neck cancers.

Unlike the current fee-for-service payments that require oversight from insurers, value-based payment models grant control to physicians and their patients while also making them accountable for outcomes.

Thomas W. Feeley

Thomas W. Feeley

Thomas W. Feeley, who leads the Institute for Cancer Care Innovation at the MD Anderson Cancer Center, points out that this set-payment program, which may hold the answer to help reform the health care payment system in the future, tests the premise that simplifying reimbursements into a one-price design encourages provider groups and hospitals to be more efficient, and rewards high quality, while giving patients a voice in their own treatment decisions and care.

How does it work? The plan establishes one set price for the patient’s treatment for an entire year. This includes services like imaging, surgery, radiation therapy, and chemotherapy. Most complications and additional treatment needs that arise during this time period will also be covered under the plan. “We never stop treating the patient as long they are at MD Anderson,” Feeley says. “They get care for what happens [in regard to this diagnosis] over the course of the year.”

For patients, this means there’s no need to delay critical treatments while waiting for insurance approval, and there are no complicated medical bills to weed through. Instead, they find out up front what their financial obligation is for the entire treatment regime for the year.

From the care team’s perspective, the plan saves staff time in the future since there’s no need to go through lengthy approval processes for patients, and no need to submit separate bills for services. “We plan to see if this decreases administrative costs at MD Anderson,” Feeley said.

You’ll learn the key aspects of this innovative payment system, including details of how MD Anderson and United Healthcare are ironing out the numerous logistical challenges, when you read the full article: Leading Cancer Center Pilots Extensive Value-Based Payment Plan.

Best regards,
Matt Humphrey

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