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 health care 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

Representative 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