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Focus Areas

Healthcare Payment Model Design

Designing and Implementing Payment Models

As the clinical and financial advantages of value-based care become clearer, healthcare payment and care delivery systems are being redesigned. In some cases, this requires the design, implementation, and evaluation of entirely new integrated care solutions.

To support new payment models, we assess and address financial and operational issues, examine changes in reimbursement structures, measure quality of care, create new reporting requirements, and design incentives to maximize provider participation. We have helped the Centers for Medicare & Medicaid Services (CMS)—the largest payer in the country—and others in developing and evaluating value-based care models and in designing and implementing new healthcare payment models.

Areas of Expertise

  • Financial and Quality Metric Development
  • Program Design, Implementation, and Evaluation
  • Patient Attribution
  • Benchmarking and Performance Assessment
  • Risk Stratification and Adjustment
  • Provider Education and Engagement

Projects

  • Primary Care First Model Options
  • Comprehensive Primary Care Initiative
  • Direct Contracting Model Options
  • Medicare Shared Savings Program
  • Financial Alignment Initiative for Medicare-Medicaid Enrollees
  • Kidney Care First and Comprehensive Kidney Care Contracting Models
  • Medicare Part C, Part D, and ACA State Marketplaces Risk Adjustment Model Research, Development, and Maintenance 
  • ​Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents