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New Jersey to Put Payment Reform Scorecard to the Test

Mary Caffrey
Catalyst for Payment Reform will use 3 states to pilot new metrics to measure how well healthcare transformation is penetrating individual markets.
Despite the unrest in Washington, DC, payment reform is very much alive in markets across the country, as employers and large purchasers of healthcare look for new ways to deliver care. In fact, Catalyst for Payment Reform (CPR), a group of progressive purchasers looking to create high-quality, affordable care, is already moving to the “next generation” of measuring the effects of reform.

CPR has launched Scorecard 2.0, a project to update its metrics for measuring how much, how well, and what types of payment reform are taking place in both the commercial and Medicaid sectors. Designed to update the Scorecards that CPR issues now, the project will ensure that the new tool “adds quality and efficiency metrics to efficiency metrics to existing Scorecard metrics, and reflects the reality of the market today,” according to information from CPR.

To test the metrics, CPR in September selected 3 state-level partners to spend the next year testing the new Scorecard. One of those partners is the New Jersey Health Care Quality Institute (NJHCQI), which serves as the regional leader for the Leapfrog Group and earlier this year issued Medicaid 2.0, a wide-ranging blueprint with 24 specific recommendations for updating and streamlining a program that spends $15 billion a year, covers 1 in 5 state residents, and consumes 20% of the state budget.

The American Journal of Managed Care® (AJMC®) recently spoke with Linda Schwimmer, president and CEO of NJHCQI about the Scorecard process and what partners will gain from the experience. Schwimmer described CPR as “very focused on improving the quality as well as reducing the cost” of healthcare services, and said the Scorecard process will offer the employers and purchasers of healthcare service the opportunity to see if the shifts from fee-for-service to alternative payment models are working.

In selecting New Jersey, CPR will test its metrics in a place where the pace of reform has been mixed. Schwimmer’s group has championed some important projects, like leading an effort to design an episode of care (EOC) to reduce C-section rates in Medicaid. She said some individual health systems and physician groups are working hard to transform the system. Data-sharing remains a sticking point—it’s one that must be addressed in the Scorecard 2.0 process, but one where everyone stands to gain.

VIDEO: Linda Schwimmer Discusses How New Scorecard Will Give Healthcare Purchasers a Better Sense of Whether APMs Are Working

“The health plans, as well as the State of New Jersey, are the largest holders of that data,” Schwimmer said. “To support this project, we’ve reached out to all those payers, and we’re going to be meeting with them to brief them on the project and to explain the benefits—both to them as well as to all New Jerseyans.”

Schwimmer explained that when it comes to saving healthcare costs, purchasers have lots of choices today: they can shift costs, they can use narrow networks, and they can try high-deductible health plans.

“One strategy is moving toward alternative payment models—and people think that they’re working, they have a sense that they’re working, because it’s aligning incentives, but we really need to know for sure—at least, whether they’re working directionally,” Schwimmer said. “So that’s really the purpose of this Scorecard. It’s to help purchasers and policymakers to know, 'Are we moving in the right direction? Are we improving quality with this focus on new models?' And if we are, let’s keep at it. And that’s what we’re really trying to show directionally, how things are going.”

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