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Legislative Alert - April 2016

Action Alert - April 2016


What is an alternative payment model?

Federal and private partners are working to change how health care is paid for to improve the quality of care and lower costs.  Now, payment is mostly fee for service - the more procedures you do, the more you get paid.  The way things are now does not work to control costs or to achieve better health.  Work is underway to change the system to an alternative payment model.


What are examples of alternative payment models?

  • Pay for Performance - you get paid more if you achieve better outcomes, such as lower cesarean rates, fewer preterm births and better rates of breastfeeding.
  • Incentive Payments - You get paid for providing a set of enhanced services that have been shown to be effective.
  • Bundled Payments - You get one comprehensive payment for an episode of care that includes everything as long as it falls within the agreed upon list of services - complete prenatal care, labor and birth, newborn care, facility services for mom and newborn, home visit.  If something happens out side of that list like a visit with a perinatalogist or a transfer to a hospital, that could be billed outside of the bundled payment.


What areas should my comments focus on?

  • Feasibility or challenges in implementing these recommendations
  • Key gaps or unintended consequences as a result of the recommendations and ideas for mitigating them
  • Ideas for additional tools or resources needed
  • Ideas for refining recommendations based on a specific experience or lessons learned
  • Examples for illustrating key recommendations


Where do I comment?


Sample comments

  • Freestanding birth centers achieve high quality outcomes, but we are often excluded from networks.  We want to be included in the system to be available to all women who wish to have care in this model
  • Including birth centers as an option for women will improve outcomes for all
  • Birth centers provide enhanced care that is very time intensive, but is also effective.  Enhanced prenatal care that works should be reimbursed at a higher level than usual care that does not have such high quality outcomes.

Or write your own comments after you read the white paper, commenting on specific sections that you would revise.

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