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Dr Stephen Ondra: Consistency Is Driving Payment Reform Momentum

Public and private payers all heading in the same direction in regards to payment reform is sending a consistent message to providers and creating alignment in healthcare, said Stephen Ondra, MD, senior vice president and enterprise chief medical officer at Health Care Service Corporation.
Public and private payers all heading in the same direction in regards to payment reform is sending a consistent message to providers and creating alignment in healthcare, said Stephen Ondra, MD, senior vice president and enterprise chief medical officer at Health Care Service Corporation.
 
During the America’s Health Insurance Plans (AHIP) National Health Policy Conference in Washington, DC, Ondra sat on a panel that discussed alternative payment models as a way to improve quality and value of healthcare.
 
AJMC: What has been the progress of implementing alternative payment models in the US?
SO: The process creating alternative payment model implementation has been one that has been catalyzed by the dynamic around the Affordable Care Act and has gained momentum at an amazing pace over the last year. Just starting with the announcement by CMS, their intent to move to 30% of their contracts in traditional Medicare to alternative payment models by the end of this year—which, by the way, they just announced they are almost a year ahead—and 50% by 2018, the Health Care Transformation Task Force, which we were a founding member of, leveraging on that and saying that we plan to have 75% of our contracts in some form of alternative payment model by 2020. Today we can say that 30% of our contracts, much like Medicare, are in alternative payment models. So we’re on the track.
 
The important part is that consistent message that the provider segment of the market is getting. You’re seeing public and private payers all heading in the same direction, very similar timelines. You’re seeing the purchasers asking for these models—the big corporate purchasers. And you’re seeing more consumers looking for more affordable markets.
 
So you’re seeing this amazing alignment of everyone in the payer space heading in the same direction. There is nothing that any other business—in this case the provider community—needs more than that consistency of message: everyone is going to the same place. Everyone is heading for that same flag. And that helps them plan. And I think that’s why you’re seeing this momentum gaining pace.
 
AJMC: Were you surprised when CMS announced it had reached its 2016 goal of moving to value-based payments so early? Or had you suspected they would?
SO: Because there is a lot of meetings like this [AHIP’s National Health Policy Conference] that people go to, I knew that they were on pace. So I had confidence in them. I think the team at CMS has been dynamic, they’ve been innovative, and so while a lot of people are very skeptical about government, I actually had a lot of faith that they were going to do it.
 
I was a little surprised they were this early. But I was not surprised they made their mark.
 


 
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