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What Will Be the Payment Model in 2020?

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"My sense is there is going to be a movement from data analysis based on claims systems to data analysis based on clinical systems," says Crosson.

This will also lead health insurers working with providers and hospitals to provide system improvements through training, education, and sharing best practices. But this collaboration doesn't mean the old frictions will disappear between the two groups.

"I think it will be more collaborative, but there is always going to be, regardless of the payment mechanism, pressure on where the level of payment is set," says Robert E. Mechanic, MBA, senior fellow at the Heller School of Social Policy and Management at Brandeis University and director of the Health Industry Forum, which is a national program established to develop strategies for improving the quality and effectiveness of the U.S. healthcare system.

Plus, this greater emphasis on quality has plenty of sticking points, such as what chronic diseases to target, how and what to measure, and how to communicate that information back to providers in an understandable and useable fashion.

"What is needed is a much more focused set of measures that people agree are important and have more uniformity across payers. That's going to take a lot of work," says Mechanic.

How to prepare
To get ready for this changing world, Mechanic suggests health insurers invest in technology that allows data to be collected and—just as important—disseminated in a manageable way for providers.

Health plans should also test new payment models before their competitors and the government force them to try something new. There are dozens of prospective payment models being discussed on Capitol Hill. "I think everybody has to start getting their toe in the water because in 10 years it is going to be a very different-looking system," Mechanic says.

Les Masterson

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