Capitation and bundled payment begins to step away from more silo-based payments so that… I think it reinforces and incentivizes being able to work across settings and make sure that care is really connected between settings and providers.
In the 90s, I was part of a capitated community-based case management care coordination model, and the payment in that model really supported providers being able to work, I think, more fluidly across settings and providers…because there was a shared incentive, because everyone would benefit from making sure that care was closely linked from setting to setting and there were no fall-throughs between the cracks.
HLM: Are there reimbursement barriers and what are they?
Lamb: I think there are a variety of reimbursement barriers. Currently, when you begin to look at siloed payment where one setting may be incentivized to really capitalize on the use of those services and not necessarily the integration of services.
In the 1990s people used to talk about the right service in the right time at the right place. When you've got payment that is isolated to one particular service or setting it makes it much more difficult to be able to coordinate across settings and to use services appropriately.
Look for part two of our discussion next week in which we talk about the care coordination that's happening in hospitals today; the challenges for patients, families, and providers; and how to bridge the gaps between the two.