Hospital Strategies in Commercial Episode-Based Reimbursement

Study Design: Qualitative arm of an explanatory sequential mixed-methods study involving semistructured interviews with hospital leaders participating in a statewide quality improvement collaborative with novel episode-based incentive payments introduced by the state's largest commercial payer....

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Bibliographic Details
Published in:The American journal of managed care 2024-06, Vol.30 (The American Journal of Managed Care 6), p.276
Main Author: Regenbogen, Scott E
Format: Article
Language:English
Subjects:
Best practice
Chief operating officers
Collaboration
Design optimization
Hospitalization
Incentives
Interviews
Leadership
Medicare
Mixed methods research
Participation
Pay for performance
Qualitative research
Quality improvement
Reimbursement
Subacute care
Success
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Summary:Study Design: Qualitative arm of an explanatory sequential mixed-methods study involving semistructured interviews with hospital leaders participating in a statewide quality improvement collaborative with novel episode-based incentive payments introduced by the state's largest commercial payer. Identifying key themes in their approaches to the program revealed that successful commercial episode-based incentive programs must: * be substantive enough to earn attention from hospital leaders or consistent with larger programs to enable synergy; * provide opportunity to succeed through both initial improved performance and sustained excellence; and * address potential malalignment between hospital objectives and the motivations of credentialed physicians. _____ Payers increasingly rely on alternative payment models to hold hospitals accountable for the total cost of episodes around hospitalization. Yet private payers account for the largest share of US health care spending,8 and their spending patterns are markedly different from those of Medicare due to younger, healthier patients; differences in contracting and market pressures; and lower utilization of postacute care.9 Accordingly, hospitals' strategies and approaches may differ in commercial episode-based incentive programs. In the previously published quantitative arm,7 we used MVC administrative claims data to evaluate the effect of this incentive program on overall episode spending by hospital and condition.
ISSN:1088-0224
1936-2692
1936-2692
DOI:10.37765/ajmc.2024.89561