Insurers test new payment models for health care providers

The patient-centered medical homes model, which has been the hallmark of one such experiment by CareFirst BlueCross BlueShield, is among the approaches receiving attention for reducing costs and reducing hospitalizations.

The New York Times: Health Insurers Are Trying New Payment Models, Study Shows
Health insurers are experimenting with new formulas for reimbursing doctors and hospitals, slowly moving away from the traditional approach of basing payments on the numbers of tests and procedures performed, according to a survey of Blue Cross insurers, among the most dominant plans in the country (Abelson, 7/9).

Reuters: New Form Of U.S. Healthcare Saves Money, Improves Quality, One Insurer Finds
In one of the largest tests of a novel way to deliver and pay for healthcare, insurer CareFirst BlueCross BlueShield announced on Thursday that 1.1 million people receiving care through its "patient-centered medical homes" last year were hospitalized less often and stayed for fewer days compared to patients in traditional fee-for-service care. Medical homes, a centerpiece of President Barack Obama's healthcare reform, have been heralded as one of the best hopes for reducing the cost of U.S. healthcare, the highest in the world, and improving its quality, which lags that of many other wealthy countries (Begley, 7/10).

Kaiser Health News: Will Health Reform Bring New Role, Respect To Primary Care Physicians?
The company's move to shift that balance tells a lesser-known story of CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients. Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy. The Affordable Care Act and efforts to change the health system. While much attention has focused on expanded coverage and online insurance bazaars, policymakers' bigger challenge is improving Americans' health while putting a brake on the cost of their care. The keys to that puzzle, CareFirst and many others are deciding, are the internists and general practitioners who have largely been left behind by health care's financial boom (Hancock, 7/10).

In related news -

Modern Healthcare: Preferred Referrals Gain Favor With ACOs
Each month, doctors at one Arizona accountable care organization get a rundown of referral patterns, including the percentage of patients who followed referrals to specialists the ACO deems preferred. Doctors get on that list thanks to strong quality scores, efficient operations and laudable customer service. But when performance falters or patients leave dissatisfied, they're dropped (Evans, 7/9).