NEJM: New way of paying for care in Mass?


longwood mapFor the uninitiated, I apologize for exposing you to this piece of jargon: “risk-adjusted capitation.” 




It means paying hospital/doctor/clinic groups a set amount per patient based on that person’s risk of getting sick.  It would replace the “fee-for-service” system of paying separately for every injection, visit, anesthesiologist, etc.  Policy makers promise this plan is more sophisticated than the blunt 1980s HMO model of capitation. Sounds like a grown-up idea to me. We’ll see. Again, many moving parts.  

From NEJM: A special commission has…proposed that Massachusetts effectively end fee-for-service medicine, the predominant form of payment for health care services, and replace it with a system of global payments that combines the approaches of risk-adjusted capitation and pay for performance with a strong focus on primary care…Although global payments are a form of capitation (payments are per patient), the Massachusetts commission sought to distinguish its model from previous capitation models. In the commission’s view, global payments would benefit from health information technology, a “careful transition period,” and monitoring to prevent “unintended consequences,” such as poor access to physicians or denial of needed care.

More from the state on global payments.

Former Globie Richard Knox reported on this for NPR.

 More on “pay for performance” here


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