For information about COVID-19, including symptoms and prevention, please read our COVID-19 patient guide. Please also consider supporting Weill Cornell Medicine’s efforts against the pandemic.

A delicate balance: Accountability for very high-cost patients in new payment models.

TitleA delicate balance: Accountability for very high-cost patients in new payment models.
Publication TypeJournal Article
Year of Publication2019
AuthorsMullangi S, Press MJ, Ryan AM
JournalHealthc (Amst)
Pagination100366
Date Published2019 Sep 23
ISSN2213-0772
Abstract

Designing alternative payment models (APMs) to encourage providers to manage the needs of very complex patients while limiting providers' financial risk is a major challenge. Most APMs limit providers' financial risk for complex patients through an annual per-patient expenditure cap, above which medical expenses are excluded from financial performance calculations. We consider three strategies to better strengthen the balance between motivation and risk mitigation. First, risk adjustment could be improved. Second, expenditure caps can be tailored to very high-cost patients. Third, payers could allow providers to determine their own risk preferences through alternative reinsurance policies.

DOI10.1016/j.hjdsi.2019.100366
Alternate JournalHealthc (Amst)
PubMed ID31558367
Division: 
Healthcare Delivery Science & Innovation
Category: 
Faculty Publication