Payment to Promote Sustainability of Care Management Models for High-need, High-cost Patients: Insights from The Health Care Transformation Task Force

KEY QUESTIONS ANSWEREDWhat are the best ways to organize payment systems to reward quality care for high-need, high-cost patients?What are the challenges to implementing such a payment system?KEY THEMES AND TAKEAWAYSThis resource reviews emerging payer and provider partnerships that incentivize value-based payment models. Key points and recommendations include:The highest-need, highest-cost population is ever-changing. Payment systems should focus on identifying the population that will benefit most from care management services. Models must periodically re-evaluate this population.Provider incentives must be based on Triple Aim outcomes -- better care for individuals, better health for populations, and lower costs. If per-member-per-month incentive payments are used, there should be metrics that are evaluated to ensure that the Triple Aim is met.Providers face financial "barriers to entry" to make initial programmatic and infrastructure investments. Preventing inappropriate and/or avoidable use of care requires upfront investments such as information technology, social supports, and expansion of primary care services.Programs are most effective when they partner with patients, empowering them to take an active role in their own care management.A form of sustainable payment is a per-member-per-month care management fee based on Triple Aim outcomes for high-risk patients, plus shared savings.Providers with existing care management programs for high-need, high-cost patients prefer full-risk capitation payments