Case Management

Position your department for payment reform

Case Management Monthly, July 1, 2010

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Four years ago, Massachusetts passed state healthcare insurance reform similar to the new federal model. 

The Massachusetts legislature realized the increasing cost of healthcare was a threat to the success of the healthcare reform initiative. In response, it created the Special Commission on the Health Care Payment System (The Special Commission) to look at ways to reduce costs.

On July 16, 2009, The Special Commission recommended the state change from a fee-for-service model and use global payments within five years. 

Global payments “compensate providers for all or most of the care that their patients may require over a contract period, such as a month or year,” according to The Special Commission’s recommendation report. 

The Special Commission believes the global payment system will incentivize providers to collaborate more effectively and encourage them to provide cost-efficient care. It recommends creating Accountable Care Organizations (ACO), which are essentially healthcare networks that manage the services throughout the continuum. An ACO could be a healthcare system or a contracted group of providers.

The shift to global payments means hospital case managers will be more involved in patient care that occurs outside the hospital. 

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.

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