Organization and Delivery of Health Care and Payment to Providers

Organization and Delivery of Care and Payment to Providers

March 1-2, 2007

All health care systems confront major challenges on how to organize the health plans' delivery system(s) and what incentives the various payment systems create. If we assume that there will be private delivery of care, what criteria should be used for determining which plans are deemed qualified? How should plans consider organizing their health care delivery systems? Should all plans be integrated delivery systems? How loose or tight should the delivery systems be? How should health plans be paid? How does payment influence the structure of the delivery system? Across the spectrum of payment, from strict capitation to some fee-for-service, what is the optimal arrangement? Some form of risk-adjustment is necessary, but beyond adjustment for sex, age, and smoking what other factors should be considered? What are the likely incentives related to different forms of risk adjustment for adverse selection? For the delivery system? How much should performance on health outcomes be incorporated into payment levels? What should be done with extremely high-cost patients? Should payment be used to reduce risk? Or should there be a separate mechanism to pay for patients whose costs exceed a certain level? How should geographic factors be considered? Should existing geographic variations in payments be reduced? How and over what time scale?

This program might be divided into two parts with two different papers; one related to the payment for care and the other on organization of health plans and delivery of care.

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