Health Care Benefits – Creating the Optimal Design

RWJF - Changes in Health Care Financing & Organization (HCFO)

Issue Brief describes the role of benefit design such as consumer-driven health plan and VBID to maximize coverage and offer incentives for quality and efficiency.

March 11, 2013

Low-Value Services in Value-Based Insurance Design

Identifies low value medical treatments in order to deter their use

March 11, 2013

State Insurance Exchanges Face Challenges In Offering Standardized Choices Alongside Innovative Value-Based Insurance

How states and health plans aim to implement VBID

March 11, 2013

Medication Adherence Changes Following Value-Based Insurance Design

VBIP design improves adherence to medications to treat cardiometabolic conditions

March 11, 2013

Value-Based Insurance Design

More Health at Any Price

This article explores value-based insurance design (V-BID), which acknowledges the importance of cost-sharing, but aligns patient contributions with the intervention’s potential for clinical benefit.

March 11, 2013

CMS Roadmaps for Quality Measurement, Resource Use and Promoting Value in Medicare: Charting a Path that Could Support Transformation in Health Care

Description of 3 "roadmaps" for achieving high value health care

March 11, 2013

A Transparency and Accountability Framework for High-Value Inpatient Nursing Care

This article outlines a framework for achieving are rewarding high-value inpatient nursing care

March 11, 2013

Open Door Forum: Hospital Value-Based Purchasing

Fiscal Year 2013 Overview for Beneficiaries, Providers, and Stakeholders

CMS presentation that details the Hospital Value-Based Purchasing program

March 11, 2013

How does Medicare value-based purchasing work?

Issue Brief that describes Medicare's Value-Based Purchasing Program, created via the Affordable Care Act, which aims to reward hospitals that meet specific quality standards

March 11, 2013

HCI3 Improving Incentives Issue Brief: Tracking Transformation in US Health Care

How Do You Know You're Making Progress?

How do you know you’re making progress? That's the question that everyone in health care should be asking, and be able to answer. In this Issue Brief we propose a few metrics that, collectively, should give us and others a better…

January 17, 2013

It’s the Incentives, Stupid!

Why Rotten Incentives Continue to Screw Up Health Care

Healthcare is plagued by many things, but none is worse than the incentives that drive physician, hospital and patient behaviors. This book is a compilation of 18 months of reflections on those incentives and offers some solutions to the problems…

October 19, 2012

HCI3 Improving Incentives Issue Brief: Designing the BPCI for Success

CMMI Bundled Payments for Care Improvement Requires Design Changes to Ensure Pilot Success

Objective: Examine the variation in costs within certain episodes of care to better quantify the risks and benefits to providers participating in the CMMI Bundled Payments for Care Improvement (BPCI). Methods: We performed a retrospective analysis of claims data using…

August 29, 2012

History and Overview of Bridges to Excellence (BTE)

August 24, 2012

The History and Overview of Bridges to Excellence (BTE) webinar from August 24, 2012 is the last of three webinars covering HCI3’s primary efforts: PROMETHEUS Payment, Evidence-informed Case Rates (ECRs) and Bridges to Excellence. This webinar covers a history…

August 27, 2012

Overview of the Prometheus Payment Model

August 21, 2012

The Overview of the Prometheus Payment Model webinar from August 21, 2012 is the first of three webinars covering HCI3’s primary efforts: PROMETHEUS Payment, Evidence-informed Case Rates (ECRs) and Bridges to Excellence. This webinar assumes no knowledge of the…

August 22, 2012

Hospitals on the Path to Accountable Care

Highlights from a 2011 National Survey of Hospital Readiness to Participate in an Accountable Care Organization

ABSTRACT: Accountable care organizations (ACOs) are forming in communities across the country. In ACOs, health care providers take responsibility for a defined patient popu- lation, coordinate their care across settings, and are held jointly accountable for the quality and cost…

August 17, 2012

Accountable Care Strategies

Lessons from the Premier Health Care Alliance's Accountable Care Collaborative

Abstract: Accountable care organizations (ACOs)—groups of providers that agree to take collective responsibility for delivering and coordinating care for a designated population—are being promoted as a means to improve health and health care while containing costs. This report shares the…

August 17, 2012

Technical Appendix 1

The warranty allowance model – division between flat fee and proportional rate

Editor’s Note: This online data supplement contains supplemental material that was not included with the published article by Francois de Brantes and colleagues, “Should Health Care Come With A Warranty?” Health Affairs 28, no. 4 (2009): w678–w687 (published…

June 20, 2012

All Roads Lead To Payment: Squeezing Value from Health Reform

A lunch briefing to explain ideas currently being discussed to reform the way providers are paid.

Ideas about how to pay providers to improve quality and reduce costs are the starting point for many discussions about national health reform. A variety of solutions are being discussed to correct widespread deficiencies and increase value in our health…

June 20, 2012

Igniting Health Care Payment Reform

A review of the PROMETHEUS Payment® approach describes the key components of a strategy to manage the rise in health care costs. Using common incentives and connecting payment to clinical practice guidelines and evidence-informed case rates can result in high…

June 20, 2012

What are Prometheus Payment Evidence-Informed Case Rates (ECRs)?

Predetermined budgets that are bundled to cover comprehensive, evidence-based, personalized care in treating a given condition.

From fee-for-service, to capitation, to episode-based models—proposals for paying providers in the United States’ health care system have come in all shapes and sizes over the decades. Tried and tested payment systems have all purported to be effective in addressing…

June 20, 2012

HCI3 Improving Incentives Issue Brief: Bundled Payment Across the U.S. Today

Status of Implementations and Operational Findings

Health policy discussion across the United States during the past few years has placed significant attention on the adverse effects of fee-for-service payment, the predominant method of paying for health care services in the country. Feefor- service payment has been widely criticized for financially motivating providers…

May 25, 2012


Will the Latest Payment Trend Improve Care?

Pay-for-Performance programs are now firmly ensconced in the payment systems of US public and private insurers across the spectrum. More than half of commercial health maintenance organizations are using pay-for-performance, and recent legislation requires Centers for Medicare & Medicaid Services…

May 3, 2012

HCI3 Improving Incentives Issue Brief: Cutting Inpatient Days and ER Visits

Study Finds Improved Focus on Population Management and Chronic Illness Cuts Inpatient Days and Emergency Room Visits

Objective: To study the cost and utilization performance of primary care physicians (PCPs) with and without a patient-centered medical home (PCMH) designation or a Bridges to Excellence (BTE) Diabetes Recognition. Methods: We performed a retrospective analysis of claims data using…

May 2, 2012

Delineating Episodes of Medical Care

The original idea for a medical episode is laid out here.  The usual measures used to document use of medical services were found insufficiently penetrating in a utilization study conducted by the authors. A useful measure which gives meaning and…

April 25, 2012

Key Design Elements of Shared-Savings Payment Arrangements

August 2011 Issue Brief

Shared savings is a payment strategy that offers incentives for providers to reduce health care spending for a defined patient population by offering them a percentage of net savings realized as a result of their efforts. The concept has attracted…

April 19, 2012