Reforming Payment Systems

NEHI’s research and analysis focuses on assessing the impact of new payment models on the development, adoption and availability of innovative therapies and technologies at the point of care. Current NEHI projects include how Accountable Care Organizations, bundled and global payments, pay-for–performance and patient centered medical homes are changing the innovation paradigm, creating new opportunities for some sectors and challenges for others. NEHI’s agenda on payment reforms includes future analysis of the need for continuing innovation in payment methods that will support improved patient outcomes and high-value care.

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Initiatives

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  • Themes Comparative Effectiveness Research Health Reform Payment Reform
    Publication Date: May 24, 2016

    2016 NEHI Annual Meeting Policy Discussion Summary

    NEHI's Annual Meeting was rich with policy discussion and cross-sector sharing.
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  • Themes Healthcare Spending Payment Reform Technology Adoption
    Publication Date: February 11, 2016

    Delivering Medical Innovation in a Value-Based World

    As accountable care organizations, bundled payments and other value-based payment models sweep the nation, NEHI works to uncover implications for innovation.
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  • Themes Health Reform Hospital Readmissions Medication Adherence
    Publication Date: June 25, 2015

    Reducing Hospital Readmissions Through Medication Management and Improved Patient Adherence

    Reducing Hospital Readmissions Through Medication Management and Improved Patient Adherence
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  • Themes Health Behaviors Healthcare Spending Health Reform
    Publication Date: May 8, 2015

    Community Health Workers: Getting the Job Done in Healthcare Delivery

    Community health workers (CHWs) have been on the front lines of health care delivery for decades, serving as a vital link between providers and the surrounding communities. This relationship has become even more important with the advent of the Affordable Care Act (ACA), as millions of Americans obtain access to care and providers are under increasing pressure to contain costs.


    To explore options for increasing the role of CHWs in improving population health, NEHI partnered with the Jewish Healthcare Foundation (JHF), Rose Community Foundation and the Association of American Medical Colleges to convene a day-long meeting in October 2014 focusing on CHWs. A subsequent invite-only meeting was held in Pennsylvania in April 2015, hosted by JHF and supported by NEHI, to dive deeper into some of these issues and explore the opportunities for Pennsylvania.

    This issue brief summarizes the history of CHWs and includes key findings from the October 2014 summit and April 2015 Pennsylvania meeting. The brief includes an analysis of:

    • CHW Impact: As community health workers are increasingly incorporated in healthcare teams, a growing body of evidence attests to their impact. These studies are highlighted in this issue brief. For example, one study found that integrating CHWs into care teams lead to a 3:1 return-on-investment.
    • Policy Actions: ACA included several provisions with impacts on CHWs, and several states have taken action to build infrastructure for CHWs. This issue brief details the policy that continues to evolve around CHWs.
    • Training Standards: Because of the opportunities and funding created by policy change at the federal and state level, there are some questions about the nature of what it means to be a CHW. The issue brief details some of these questions and provides an examination of the opportunities to increase training and enhance professional recognition.
    • Pioneers: The issue brief also highlights some of the exemplar models using CHWs to improve quality of care and reduce costs, including the Camden Coalition of Health Care Providers, the Penn Center for CHWs, and Hennepin Health.
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  • Themes Health Reform Payment Reform Technology Adoption
    Publication Date: December 17, 2014

    All Payer Claims Databases: Unlocking the Potential

    This Issue Brief reflects findings from the event, in addition to background research and expert interviews conducted by NEHI to explore the opportunities and lessons learned in leveraging APCDs to advance health services research.
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  • Themes Payment Reform Technology Adoption
    Publication Date: November 13, 2014

    A Bundle of Potential and Risk: Bundled Payment and its Impact on Innovation

    This Issue Brief reflects findings from the event, in addition to background research and expert interviews conducted by NEHI on what this changing landscape means for patient access to innovative therapies and medical devices.
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  • Themes Accountable Care Payment Reform Telemedicine
    Publication Date: April 26, 2013

    ACO Innovation Summit Series

    An overview of a series of dynamic summits hosted by NEHI for senior leaders for a multi-sector exploration of the potential impact of ACOs on patient access to innovative therapies and technologies. Since passage of the Affordable Care Act, more than 450 Accountable Care Organizations have been established in 49 states. While ACOs are in the spotlight as a means to transform the health care delivery system, many challenges need to be addressed. NEHI has taken the lead by convening a series of dynamic summits for senior leaders from pioneer ACOs, academia, biopharma and medtech for a multi-sector exploration of the potential impact of ACOs on patient access to innovative therapies and technologies.
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  • Themes Chronic Disease Healthcare Spending Health Reform
    Publication Date: April 26, 2012

    2012 Innovation Barometer

    A national survey of 500 opinion leaders shows strong support for using innovative solutions to increase efficiency and control costs in health care.
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  • Themes Evidence-based Medicine Healthcare Spending Payment Reform
    Publication Date: March 1, 2012

    Exploring Innovative Pricing Arrangements for Biopharmaceuticals

    This Issue Brief discusses critical barriers to expanded use of innovative pricing arrangements, strategies to overcome them and alternative ways to ensure access and continued innovation of biopharmaceuticals.
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  • Themes Comparative Effectiveness Research Evidence-based Medicine Payment Reform
    Publication Date: February 17, 2011

    From Evidence to Practice: A National Strategy for CER Dissemination

    Since the passage of the ACA, NEHI has been examining the potential avenues for CER dissemination, specifically the existing programs of the Agency for Healthcare Research and Quality (AHRQ) and the newly created Patient-Centered Outcomes Research Institute (PCORI). This white paper takes the position that PCORI must elevate dissemination as a priority, above and beyond the level called for in the Affordable Care Act and in the Institute of Medicine’s 2009 report to Congress on CER priorities.
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NEHI'S Impact

For Our Members 

"NEHI’s involvement in the ACO conversation is really about the organization they are, the knowledge that they bring and the platform they provide as the key thought leaders and stakeholders who aren’t specific to oncology. I think you need a neutral party sometimes to have these conversations. And they have done incredible work on bending the curve of healthcare costs and all of their other work that they’ve done to lay the groundwork for healthcare in a new era."-Molly Muldoon, Vice President of Government Affairs and Health Policy, Onyx Pharmaceuticals 

In the Media

"ACOs, even at this early stage, are changing the innovation paradigm, creating new opportunities for some sectors and new challenges for others. For payers and providers, ACOs have opened the door for innovative new payment and care delivery models. But at the same time, there are new pressures on the biopharmaceutical and medtech industries to demonstrate the value of their innovations in ways not required in the past."- Network for Excellence in Health Innovation, featured in the Health Affairs Blog

 

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