previously reimbursed; or payment for a new service 16 40.0 Pay-for-performance Bonus or incentive payments for performance in clinical process or outcome measures 24 60.0 Individual provider — b 7 17.5 Clinical team — b 3 7.5 Entire practice (clinical and nonclinical) — b 11 27.5 ACO or health plan — b 2 5.0 Community health worker — b 3 7.5 Episode-based bundled payment Set amount to manage a specific bundle of services, usually surrounding an acute event (such as pregnancy and hospitalization) 8 20.0 Capitated or global payment Set amount to manage care for a given population over a specified time 13 32.5 Gain sharing or shared savings Agreements whereby savings in the cost of care are shared between a payer and a health care organization 10 25.0 No payment reform — b 4 10.0 SOURCE Authors ’ analysis. NOTE ACO is accountable care organization. a Twenty-two (55.0 percent) of the forty applicants to the Robert Wood Johnson Foundation ’ s Finding Answers program proposed multiple reforms. Some pay-for-performance plans rewarded multiple entities. b Not applicable. June 2017 36:6 Health Affairs 1135 Downloaded from HealthAffairs.org on May 30, 2019. Copyright Project HOPE—The People-to-People Health Foundation, Inc. For personal use only. All rights reserved. Reuse permissions at HealthAffairs.org.
Care Delivery Interventions Most (87.5 percent) of the applications pro- posed multifaceted approaches with multiple interventions (Appendix Ex- hibit A4). 21 The majority (62.5 percent) proposed educating either patients (40.0 percent) or providers (35.0 per- cent). More than half (62.5 percent) proposed to restructure the care team — for example, by adding a social worker or allied health professional. Other com- mon interventions included engaging the community (40.0 percent), increas- ing access to testing and screening (40.0 percent), providing reminders and feedback to providers (37.5 per- cent), restructuring the care visit (25.0 percent), and expanding support services (17.5 percent). A few applica- tions proposed patient financial incen- tives (12.5 percent). Funded Applications The three funded applications highlight some of the approaches found most compelling by the newer Finding Answers pro- gram ’ s technical expert panel (Exhib- it 2). Though none of the applicants met the full selection criteria in the call for proposals, the funded applicants ’ proposals were most closely aligned with the program ’ s goals, and the grant- ees have further evolved to meet the pro- gram's aims with guidance from the Finding Answers national program office. ▸ UNIVERSITY OF WASHINGTON AND ADVANTAGE DENTAL SERVICES , ORE- GON : The University of Washington partnered with Advantage Dental Ser- vices, in Oregon, to target disparities in oral health outcomes via improve- ments in access to dental care (by changes to the care team and going out- side of the traditional clinic to provide care) and the use of dental services by low-income children and pregnant women in seven rural counties in Ore- gon, compared with similar patient pop- ulations in seven comparison counties.
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