Nation’s Largest Commercial Value-Based Healthcare Program Delivers on Triple Aim

Case Study: Horizon Healthcare Services

Even before the Affordable Care Act, Horizon Healthcare Services of New Jersey set out to change how healthcare is delivered. A few years into its initiative, the company runs the largest commercial Episodes of Care (specialty-value-based) program in the country,…

February 2, 2016

Health Information Technology in the United States, 2015

Why Payment Reform and HIT Interoperability Must Follow the Same Innovation Route

In the January 2007 issue of the Journal of Healthcare Information Management, we argued that the American health care system is “a dark, lumpy archipelago composed of tens of thousands of isolated corporate islands that, at least in terms of …

September 17, 2015

Measuring Provider Performance

PAC Rate Performance Measurement

July 22, 2015

Modes of Payment Discourage Information Sharing

Relationship Between Payment and Information Sharing

April 16, 2015

Getting Accurate Price Estimates from Price Transparency Tools

For millions of Americans, health care is increasingly becoming a retail market. More than one in five Americans with private insurance is enrolled in a high deductible health plan. According to the 2014 Kaiser Family Foundation survey of health care benefits, 61 percent…

February 5, 2015

The Medical Cost “Sweet Spot”

The Core of Specialty Demand

October 17, 2014

Change in Health Plan Enrollments

The "One-Stop" Medical Experience Fails to Gain Traction

October 17, 2014

The DRG Mismatch

Is it chest pain or something else? Is it an AMI or CABG or both?…

June 27, 2014

Key Payer and Provider Operational Steps for Successfully Implementing Bundled Payment

This is the third in a series of annual issue briefs that have tracked the development and implementation of bundled payments in the public and private sectors.  This brief builds upon the two previous issue briefs  by providing a more…

May 28, 2014

Report Card on State Price Transparency Laws – 2014

March 25, 2014

Dear Colleagues, When we released our inaugural Report Card on State Price Transparency Laws in 2013, it was the first time policy makers, consumer advocates, and other health care leaders had a comprehensive resource showing how readily consumers could find…

March 24, 2014

Attending Orthopedic Surgeons’™ Estimates Of Device Costs, By Device Cost.

How well do orthopedic surgeons estimate the costs of joint implants? from Health Affairs 2014; 33:103-109…

January 14, 2014

State Report Card on Transparency of Physician Quality Information

HCI3 Improving Incentives Report - December 2013

Introduction In its seminal publications on the Quality of Health Care in America, the Institute of Medicine called for the measurement and reporting of physician quality. That was in 1999 and 2000. Since then much work has been done in…

December 6, 2013

Reference Pricing and Bundled Payments

A Match to Change Markets

As the costs of health care continue to increase, employers are turning to innovations in health care payment, benefit design, and network design to manage their costs. One reform that has gotten recent attention is reference pricing. Yet when used alone, this strategy…

November 14, 2013

Legal Issues in Designing Bundled Payments and Shared Savings Arrangements in the Commercial Payor Context

A promising method for restructuring the health care payment system involves packaging payments for multiple, related services into a “bundle” to pay for a single episode of care. For example, a bundled payment for a hip replacement surgery would include…

September 10, 2013

Improving Incentives to Free Motivation

“Improving Incentives to Free Motivation,” calls for an approach to payment reform that harnesses the inherent motivation that doctors and patients have to make good decisions about health care. The authors reject the assumption that health care costs will drop…

August 7, 2013

Model State Health Care Price and Quality Transparency Legislation

In March 2013, the Health Care Incentives Improvement Institute and Catalyst for Payment Reform issued a report card ranking each state in the US on the availability and accessibility of health care services pricing. In December 2013, another report card…

July 25, 2013

Bundled Payments One Year Later

An Update on the Status of Implementations and Operational Findings, May 30, 2013

Foreword Form drives function and incentives drive function. That’s the basic principle that is driving so many to focus on moving away from fee for service to alternative payment models. In March, Catalyst for Payment Reform issued a scorecard showing…

June 10, 2013

Of Regional Cost Variation

Chronic Conditions: PAC Costs Drive Total Cost Variation

Of Regional Cost Variation is a set of two slides showing how potentially avoidable complication (PAC) costs drive total cost variation in chronic conditions as well the variation in PAC rates across states. …

May 31, 2013

Rhode Island – Health Insurance Bulletin 2013-1

Health Care Price Transparency

 (a) Purpose. This Bulletin is issued by the Office of the Health Insurance Commissioner [of Rhode Island] for the purpose of communicating to health insurance issuers the Commissioner’s interpretation of their obligations under state laws and regulations to disclose to…

May 23, 2013

Of Price, PACs, and Patients

Understanding Sources of Variation in Healthcare Costs

These slides (PDF format) allow you to explore and understand sources of variation in healthcare costs using graphs and charts based on empirical data. …

May 23, 2013

Designing Incentives to Improve Care: Tools from the Leapfrog Group

The Leapfrog Group is a coalition of many of the nation's largest corporations and public agencies founded by The Business Roundtable, a national association of Fortune 500 CEOs, to address patient safety and quality issues in the American health care…

March 22, 2013

Physician Pay-for-Performance in Medicaid: A Guide for States

Medicaid, one of the largest health care purchasers in the country, can play a leading role in testing the viability of physician-level pay-for-performance (P4P) strategies to improve health care quality for low-income, racially diverse, and chronically ill individuals. Physician Pay-for-Performance…

March 22, 2013

Wellness Incentives, Equity, and the Five Groups Problem

The study's author, 2009–10 Commonwealth Fund Harkness Fellow Harald Schmidt, characterized employees as belonging to one of five groups: "the lucky ones," whose behavior is effortlessly compatible with wellness goals; "the yes-I-can" group, who welcome the opportunity to join an…

March 22, 2013

Shared-Savings Payment Arrangements in Health Care: Six Case Studies

Driven by widespread interest in improving health care quality and reducing costs and by the Affordable Care Act’s "accountable care" provisions, shared-savings programs are gaining traction as an alternative approach to paying health care providers. Providers receive a share of…

March 22, 2013

Aligning Incentives in Medicaid: How Colorado, Minnesota, and Vermont Are Reforming Care Delivery and Payment to Improve Health and Lower Costs

Colorado, Minnesota, and Vermont are pioneering innovative health care payment and delivery system reforms. While the states are pursuing different models, all three are working to align incentives between health care payers and providers to better coordinate care, enhance prevention…

March 22, 2013