Evidence-informed case rates: a new health care payment model

Evidence-informed case rates: a new health care payment model

Collection:
Health Policy and Services Research
Contributor(s):
de Brantes, François.
Camillus, Joseph A.
Commonwealth Fund.
Publication:
[New York, N.Y.] : Commonwealth Fund, [2007]
Language(s):
English
Format:
Text
Subject(s):
Evidence-Based Medicine -- economics
Models, Economic
Prospective Payment System
Reimbursement Mechanisms
United States
Genre(s):
Practice Guideline
Technical Report
Abstract:
As a way to address the flaws of traditional payment methods, like fee-for-service and capitation, the authors of this report suggest a new payment model, based on evidence-informed case rates (ECRs). Under this system, providers are paid a single, risk-adjusted payment across inpatient and outpatient settings to care for a patient diagnosed with a specific condition. Working with experts in the health care field, the authors selected 10 conditions for ECR development, examining issues like diagnosis, services covered by the ECR, and criteria for successful completion of care. This new model, say the authors, can improve health care quality, lower administrative burden, enhance transparency, and support a patient-centered, consumer-driven environment. To further promote quality care, the ECR model calls for a portion of the payment to be withheld and re-distributed based on provider performance on measures of clinical process, outcomes of care, and patient experiences.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
Illustrations:
Illustrations
NLM Unique ID:
101316848 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/101316848