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支付方式改革与与支付方合作——推进人群健康目标和实现儿童健康公平的关键考虑因素。

Alternative Payment Models and Working with Payers-Key Considerations for Advancing Population Health Goals and Achieving Child Health Equity.

机构信息

Nemours Children's Health, 1201 15th Street Northwest, Suite 520, Wilmington, DE, USA.

Nemours Children's Health, 1600 Rockland Road, Wilmington, DE 19803, USA.

出版信息

Pediatr Clin North Am. 2023 Aug;70(4):667-682. doi: 10.1016/j.pcl.2023.03.005.

Abstract

This article summarizes approaches to achieving value-based care in Pediatrics, providing a framework for understanding the continuum of models from fee-for-service to advanced alternative payment models. We present key examples of how alternative payment models have been developed and applied at the federal level within Medicare through the work of the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicaid and Medicaid Innovation (CMMI). We further describe key lessons learned and opportunities to adapt value-based payment models to promote whole child health and equity. Finally, we summarize policy considerations and challenges in achieving accountability and aligning financial incentives for children's health within a complex payer landscape.

摘要

本文总结了在儿科学中实现以价值为基础的医疗保健的方法,为理解从按服务收费到高级替代支付模式的模型连续体提供了一个框架。我们介绍了一些关键的例子,说明在联邦医疗保险中,医疗保险和医疗补助服务中心(CMS)和医疗补助和医疗创新中心(CMMI)是如何通过工作来制定和应用替代支付模式的。我们进一步描述了从基于价值的支付模式中吸取的关键经验教训和调整机会,以促进儿童的整体健康和公平。最后,我们总结了在复杂的支付环境中实现儿童健康的问责制和调整财务激励措施的政策考虑因素和挑战。

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