Sign Up for Email Alerts Visit us on Twitter Visit us on Facebook Visit us on YouTube Subscribe to RSS Feeds

Home > Past Briefings > Briefing Detail Page

Briefing Detail Page

Change Text Size:   Smaller Text Size   Larger Text Size   Default Text Size    

Coping with Fragmented Payment in the Real World

Friday, April 13, 2012

Many analysts and policymakers agree that the fragmentation of the health care delivery system results in uncoordinated care, frustrated patients, higher costs, wasted administrative dollars and lost opportunities for rapid improvement in our health care system. There is less agreement as to how to reform health care payments in order to harmonize health care delivery and reduce this fragmentation. How do institutions, communities and practitioners transform their organizations to deliver high-quality, patient-centered care when different payers pay at different rates, and some patients have no one paying at all?

To answer this important question and related ones, the Alliance for Health Reform and The Commonwealth Fund sponsored an April 13 briefing. Speakers were: Steve Safyer, Montefiore Medical Center, NY; Gregory Reicks, Grand Junction, CO; John Colmers, Johns Hopkins Medicine, who chairs the Maryland Health Services Cost Review Commission; and Jim Bentley, health policy consultant, Silver Spring, Maryland. Stuart Guterman of Commonwealth and Ed Howard of the Alliance co-moderated.

These experts focused on three communities that have reformed and harmonized health care payments across payers to improve care: a New York health system that serves a low income population; a Colorado community that pools money from public and private sources to provide care for all patients; and the State of Maryland, which has been using an all payer hospital rate setting system for years to control hospital costs and help cover the cost of care for their uninsured.


 Stu Guterman, The Commonwealth Fund, Moderator
 Steve Safyer, Montefiore Medical Center, NY, Speaker
 Gregory Reicks, Foresight Family Physicians, Grand Junction, CO, Speaker
 John Colmers, Maryland Health Services Cost Review Commision, Speaker
 Jim Bentley, Health Policy Consultant, Silver Spring, MD, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Coping With Fragmented Payment in the Real World (Adobe Acrobat PDF), 4/24/2012
Full Webcast/Podcast: Coping with Fragmented Payment in the Real World

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Stuart Guterman's presentation (PowerPoint), 4/13/2012
Steve Safyer's Presentation (Adobe Acrobat PDF), 4/13/2012
Gregory Reicks's Presentation (PowerPoint), 4/13/2012
John Colmers's Presentation (PowerPoint), 4/13/2012

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Word Document), , 4/13/2012
Speaker Biographies (Adobe Acrobat PDF), , 4/13/2012
Materials List (Adobe Acrobat PDF), , 4/13/2012
Source List (Adobe Acrobat PDF), , 4/13/2012

Offsite Materials (briefing documents saved on other websites)

Testimony to the Joint Committee on Health Care Financing (Adobe Acrobat PDF),Pioneer Institute, 5/1/2011
- Joshua Archambault
Accountable Care Organizations in Medicare and the Private Sector: A Status Update, Urban Institute and Robert Wood Johnson Foundation, 11/1/2011
- Robert Berenson and Rachel Burton
Next Step for ACOs: Will This New Approach to Health Care Delivery Live Up to the Dual Promises of Reducing Costs and Improving Quality of Care?, Health Affairs, 1/31/2012
- Robert Berenson and Rachel Burton
Montefiore Medical Center: Integrated Care Delivery for Vulnerable Populations, Commonwealth Fund, 10/1/2010
- Deborah Chase
Maryland’s All-Payor Hospital Payment System, The Maryland Health Services Cost Review Commission, 3/1/2009
- Harold Cohen
The End of Health Insurance Companies, New York Times, 1/30/2012
- Ezekiel Emanuel and Jeffrey Liebman
Cost Control the Next Step for Massachusetts Health Reform, American Medical News, 3/28/2011
- Tanya Albert Henry
How Much Was That Treatment? , New York Times, 3/24/2012
Expect the Unexpected? Physicians’ Responses to Payment Changes (Adobe Acrobat PDF),National Institute for Health Care Management , 11/1/2010
-  Mireille Jacobson and Joseph Newhouse and John MacArthur.
New Method Needed for Setting Health Care Payment Rates, Experts Say, Commonwealth Fund, 10/25/2010
Grand Junction, Colorado, A Health Community That Works (Adobe Acrobat PDF),New America Foundation, 8/1/2009
-  Len Nichols and Micah Weinberg and Julie Barnes
Why Accountable Care Organizations Won’t Deliver Better Health Care – and Market Innovation Will, Heritage Foundation, 4/18/2011
- Rita Numerof
Setting Hospital Rates to Control Costs and Boost Quality: The Maryland Experience, Health Affairs , 9/1/2009
- Robert Murray
The Many Different Prices Paid to Providers and the Flawed Theory of Cost Shifting: Is It Time For a More Rational All-Payer System? (Adobe Acrobat PDF),Health Affairs , 11/1/2011
- Uwe Reinhardt
“In Praise of Price-Fixing, National Journal , 3/19/2012
- Margot Sanger-Katz
Single Payer Ahead – Cost Control and the Evolving Vermont Model, The New England Journal of Medicine, 8/18/2011
- Anya Rader Wallack
Grand Junction, Colorado: A Health Community That Works (Adobe Acrobat PDF),New America Foundation, 8/1/2009
- Len Nichols and Micah Weinberg and Julie Barnes


Uwe Reinhardt Questions Bundled Payment Savings Prospects

Video (2:58)

A new Alliance for Health Reform video features Princeton’s Uwe Reinhardt questioning whether bundling payments for medical services might actually lead to higher – not lower – costs.

"The ACO's, the accountable care organizations, could create local monopolies that could dictate to you what that bundled price would be, and some of us fear that bundled prices might be even more than what the fee-for-service for that bundle would be today. … You really should align all the payers and say, 'Let us jointly negotiate with the ACOs what those bundles should be so that they cannot divide and rule and sort of make us on the buy side weak.'"


Read More 

Sister Carol Keehan on Health Law Enrollment Challenges this Year

Video 3:00

A new Alliance for Health Reform video features Sister Carol Keehan of the Catholic Health Association of the United States addressing the challenges of quickly enrolling millions of Americans for health insurance this fall. Open season begins October 1 of this year, yet she says that up to 85 percent of those who will be newly eligible for Medicaid or for subsidies to buy private insurance in state-based exchanges don't know it.  FULL TRANSCRIPT

Read More 

Jonathan Blum on CMS Efforts to Keep Medicare Spending Growth Down

Video (2:54)

Jonathan Blum, acting principal deputy administrator and director of the Center for Medicare at the Centers for Medicare and Medicaid Services (CMS), addresses the slower growth of Medicare spending over the last few years, and what his agency is doing to try and continue the trend. “There are promising signs that this strategy to change the payment system, to change the payment models, to focus on waste and abuse, is paying off," he said. "We are taking a whole new approach to addressing fraud in the program. Much more data resources, much more on the ground reaction. We have seen dramatic spending declines in areas of spending, such as home health and durable medical supplies that historically fueled lots of the fraud.”  FULL TRANSCRIPT

Read More 

Two Former Medicare Administrators Discuss How to Save the Program

A new Alliance for Health Reform video features two former Medicare administrators -- Gail Wilensky and Bruce Vladeck -- on their ideas about how to save the program.

Ms. Wilensky, who ran Medicare in a Republican administration, argued for increasing the eligibility age of Medicare for future retirees, while still making the program available at age 65 for those who are disabled.

Watch at

Read More 

Douglas Holtz-Eakin: Health Care Spending Lull Only Temporary

Video (3:11)

A new Alliance for Health Reform video features Douglas Holtz-Eakin of the American Action Forum, and a former director of the Congressional Budget Office, arguing that recent slower spending growth in health care won’t continue.

"We also saw a slowdown in the mid-90s, and we all declared victory and it came right back. I think next year we’ll see a noticeable uptick. There will be lots of new people entering the insurance markets because of the exchanges and the subsidies that come along with them, and those subsidies are very generous. … These are an invitation for people to get coverage and to buy more health care. I think that’ll place a lot of pressure on spending."


Read More 

Marketplace Enrollment Helpers Toolkit

Beginning October 1, insurance marketplaces open for enrollment, and millions of people will be eligible to purchase plans. To guide them in the application process, the federal government has invested in programs to train community organizations and hired staff.

Read More 

The Employer Mandate of the Patient Protection and Affordable Care Act

The Toolkit, available here, details the ACA’s employer requirements and penalty. It also includes information about the delay in the mandate to 2015, and analysis about its impact on employer-based coverage.

Read More 

Toolkit: Training the Workforce for a Changing Health System

A new Alliance for Health Reform toolkit addresses concerns about whether newly-trained physicians are adequately prepared for today's evolving health care delivery system. Does training adequately emphasize care coordination, team-based care, costs of care, health information technology, cultural competence and quality improvement? Does it encourage students to practice in a primary care setting?

Read More 

Toolkit: Emergency Preparedness in the U.S.: The Ebola Threat

Is the U.S. prepared for a potential virulent pandemic? This new Alliance toolkit examines public health infrastructure, funding and policy levers that deal with these kinds of health crises in America.

Read More 

Copyright 1997-2014 Alliance for Health Reform
1444 Eye Street, NW, Suite 910 Washington, DC 20005-6573      202-789-2300      202-789-2233 fax      Sitemap