New Payment Models

New payment models that reward value over volume are needed to sustain improvements to the delivery system as demonstrated by the CARE Award.

An optimal route for expediting the movement to alternative payment models for this population is integrating into state or Centers for Medicare and Medicaid Services (CMS) emerging models. Five children’s hospitals implemented new payment models in the CARE Award to sustain the care coordination model by providing resources for care coordination, care planning, dynamic care teams and enhanced contact with patients. The remaining five hospitals are in varying stages of evaluating options for new models.


Payment Model Guidance

It’s critical to align payment incentives to a care delivery model that supports a focus on families, the use of care coordinators, enhanced relationships across providers, and primary care physician partnerships.


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New Payment Model Progress

The first and most critical step for St. Joseph’s Children’s Hospital in Tampa, Florida, was gaining the support from the Medicaid program for the state of Florida. Keri Eisenbeis, director of Government Relations and Community Outreach, worked to build the relationship that would result in the CARE Award’s first payment model. “Ultimately we determined that we must share a common approach around management of this population to be on the same page or execute an agreement. The up-front commitment we gained pulled us through to the finish line.”

“A shared commitment to this population allowed us to get a payment model accomplished.”


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Summary

Sustaining CARE with Alternative Payment Models 

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Impacting the Health Care Spend for Children with Complex Conditions

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Alternate Payment Models: Key Actuarial Lessons

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Patient Acuity and Selection Efforts

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CMC Risk Thresholds

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