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For alternative payment models to work, align provider and consumer strategies

Health Affairs blog post calls on need to combine payment reform with consumer engagement

As the shift toward value-based payment models increases, so does the need to align both provider-facing initiatives and consumer-facing strategies. Blending both parts together to create one solid entity--much like a good peanut butter and jelly sandwich--is no easy feat, noted Health Affairs.

The post pointed to certain barriers facing the transition and the importance of identifying any impediments. For instance, consumer-facing tools may seem like an obstacle on the surface but can actually encourage individuals to "access those same services on which their clinicians are benchmarked and financially rewarded for providing."

Another example: Current Internal Revenue Code interpretations allow Health Savings Account qualified high deductible health plans to cover only a basic set of preventive services on a pre-deductible basis. The rules prevent certain guideline-recommended services to help individuals manage chronic diseases from being covered before meeting the plan deductible.

However, demonstrating flexibility to cover individuals on a pre-deductible basis--by using alternative payment methods--shows how payment reform and person-centered engagement can blend together, Health Affairs said.

Lastly, the post said, the idea of payment reform as a good PB&J can be seen in Medicare Advantage (MA) plans. Current laws do not allow variation in beneficiary cost-sharing for guideline-recommended services for certain chronic conditions. But tying in other innovations, such as Value-Based Insurance Designs (V-BID), may solve the issue at hand. The Centers for Medicare & Medicaid Services seeks input on potential solutions, Health Affairs pointed out, while legislation was introduced last year to explore the relationship between V-BID and MA plans.

Aligning payment reform and benefit design will be an industry-wide effort, and payers specifically can help ease the transition to value-based payment models by getting providers on board, FierceHealthPayer previously reported.

For more:
- here's the Health Affairs post

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