It is clear that the way that health care gets paid for in the United States is undergoing rapid change. What is not at all clear, at least not to me, is exactly what the payment model will look like in the future, or how far off that future is. Although everybody agrees with Yogi's assessment that, “It's tough to make predictions, especially about the future,” this exercise seems particularly challenging because of the wide variety of “alternative payment models,” likelihood that they will co-exist, and the prevalence of regional differences.
It is because of this complexity that I found a recent paper in the Annals of Internal Medicine to be helpful. It is a simple “field guide” to different payment models that starts with distinguishing the “unit of payment” (e.g., per unit of time, per episode of care, per beneficiary, etc.) and then uses these to review efforts at payment reform over time.
I found this helpful in keeping all of these things straight in my head, and I liked the way it started from “first principles.” I think it is worth the read.
What do you think?
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.