Health Policy After the SGR: What’s Possible in Value-Based Payment and Benefits?

NCHC Writers
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Shaun Frost, MD, Associate Medical Director for Care Delivery System, HealthPartners Health Plan: Value Based Insurance Design: Key Concepts and their Application at HealthPartners Health Insurance Plan

William Kramer, MBA, Executive Director for National Health Policy, Pacific Business Group on Health: Health Policy after the SGR: Moving Towards Value-Based Payments and Benefits

Mara McDermott, JD, MPH, Director of Federal Affairs, CAPG: Post-SGR Opportunities for Value-Based Healthcare Delivery


“If there’s no SGR, what will we do all day?” This facetious quip has long brought smiles to the faces of advocates and Hill staff. But if Congress does manage to end the annual “doc fix” ritual, the work of reforming health care reimbursement and benefits is only just beginning. Recently announced goals, like driving 50% of traditional Medicare reimbursement through alternative payment models and basing 75% of private-sector payment arrangements on value, seem miles off.

To help map out a route toward achieving these goals, NCHC has brought together panelists with two specific qualifications. First, the private-sector physician groups, health plans and employers have each achieved real-world savings and care improvement, through new models of provider reimbursement and benefit design. Second, they each have ideas about what policymakers can do to bring those successes to scale—after the SGR.

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