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What Will Be the Payment Model in 2020?

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Common among a coming array of payment models will be greater data sharing.

This is the first in a three-part series of articles profiling the health plan of 2020. This month, we look at how health insurers will pay providers.

Don't expect one payment model in 2020. There will be a hodgepodge of global payments, bundled payments, quality payments, and yes, even fee for service. But one commonality among all forms of payment will be greater collaboration between health insurance companies and physicians and hospitals.

Health insurers will create data-sharing networks with providers and hospitals that will allow both sides to have immediate clinical information. With this data, health plans will know whether a provider is offering quality care and the provider will know almost immediately if a health plan is not satisfied with the care offered—instead of waiting months for health plans to comb data and provide payment with little or no feedback.

Jay Crosson, MD, senior fellow of the Kaiser Permanente Institute for Health Policy and founding executive director of the Permanente Federation, which focuses on standardizing patient care and performance for the integrated health system, says healthcare has made strides in measuring quality over the past decade, but measurement tools are still awkward, don't offer enough clinical information, and can lead to tedious chart review.

Greater use of electronic medical records will improve quality data collection and dissemination.

In 2020, most physicians will use EMRs that will be searchable and analyzable across multiple data points. So, for instance, a physician will be able to chart hypertensive patients with a click of a button to highlight clinical data, such as blood pressure readings, and pharmacy data that will provide information about refills and how patients are reacting to different medications. Apply that across other expensive chronic illnesses, and physicians and health plans could see improvements in outcomes—and health plans could use that data to track the quality of services provided.

But with those advanced EMRs will come ethical questions: Who owns the data and who is able to analyze the information? Is it the government? The provider? The health insurance company? Or the individual patient?

Array of expectations
Kip Piper, MA, FACHE, president of Health Results Group, a healthcare consultancy based in Washington, DC, says payment will be tied to expectation of performance in a number of different ways, such as quality, safety, and access. This movement will move performance processes from "opaque to transparency," he adds.

"I think what we're going to see are payment systems that are going to incorporate an increasing array of expectations. That then leads to the next step: Once you have performance expectations, you need to measure it and ultimately disclose it," says Piper.

This means health plans will have to give providers information that will help them improve their care.

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