Health Affairs July 2, 2018
Merle Ederhof, Alexander L. Chin, Jeffrey K. Jopling

In an effort to create health care organizations that sustainably deliver high-quality, cost-effective care, the Centers for Medicare and Medicaid Services (CMS) are using innovative payment models to push physicians and provider organizations toward improved care coordination and eventual population-based payment. The new payment mechanisms that CMS has introduced have largely focused on reducing reimbursement that is, revenue) to providers by incentivizing the reduction of unnecessary utilization. However, it has proven challenging for the models, which focus on costs from the payer perspective, to achieve the desired effect of reduced Medicare spending. Nonetheless, CMS is continuing the shift toward population-based payment with initiatives, such as the all-inclusive population-based payment option in the Next Generation accountable care organization (ACO) model, which require that...