Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands.

In the Dutch health care system, health insurers negotiate with hospitals about the pricing of hospital products in a managed competition framework. In this paper, we study these contract prices that became for the first time publicly available in 2016. The data show substantive price variation between hospitals for the same products, and within a hospital for the same product across insurers. About 27% of the contract prices for a hospital product are at least 20% higher or lower than the average contract price in the market. For about half of the products, the highest and the lowest contract prices across hospitals differ by a factor of three or more. Moreover, hospital product prices do not follow a consistent ranking across hospitals, suggesting substantial cross-subsidization between hospital products. Potential explanations for the large and seemingly random price variation are: (i) different cost pricing methods used by hospitals, (ii) uncertainty due to frequent changes in the hospital payment system, (iii) price adjustments related to negotiated lumpsum payments and (iv) differences in hospital and insurer market power. Several policy options are discussed to reduce variation and increase transparency of hospital prices.

Oncology payment reform to achieve real health care reform.

Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high-quality cancer care. However, payment reforms create new uncertainties for oncologists and may be challenging to implement. In this article, we illustrate how accountable care payment reforms that directly align payments with quality and cost measures are being implemented and the opportunities and challenges they present. These payment models provide more flexibility to oncologists and other providers to give patients the personalized care they need, along with more accountability for demonstrating quality improvements and overall cost or cost growth reductions. Such payment reforms increase the importance of person-level quality and cost measures as well as data analysis to improve measured performance. We describe key features of quality and cost measures needed to support accountable care payment reforms in oncology. Finally, we propose policy recommendations to move incrementally but fundamentally to payment systems that support higher-value care in oncology.

Managed competition in the Netherlands-a qualitative study.

BACKGROUND: In 2006, the Health Insurance Act changed Dutch health insurance by implementing managed competition, whereby the health insurance market is strongly regulated by the government. The aim of the study is to investigate key stakeholders' opinions about effects of recent changes in Dutch healthcare policy, focussing upon three important requirements for successful managed competition: risk-adjustment, consumer choice and instruments for managed care. METHOD: Expert interviews with 12 key stakeholders were performed (October/November 2009), transcribed and analyzed in a four-step qualitative process. RESULTS: The Dutch risk-adjustment scheme is very advanced but incentives for health insurers to select risks remain. The Health Insurance Act has given insurers new incentives to focus upon consumer needs and preferences, whereby large group contracts have replaced individual consumer choice with collective decision-making. Managed care concepts are slow in developing. Patient organizations and insurers report taking part in such efforts, but other stakeholders do not perceive that progress has been made. CONCLUSIONS: The pre-requisites for successful managed competition in the Netherlands are not yet entirely in place: risk-adjustment schemes cannot yet counteract all incentives to select risks, consumer preferences are just beginning to influence insurer policies and managed care elements are currently in the development stage.

Unveiling the unicorn: a leader's guide to ACO preparation.

The great uncertainty surrounding healthcare reform provides little incentive for action. However, as healthcare leaders wait for final rules and clarity about accountable care organizations (ACOs), inaction is the inappropriate response. Several central themes emerge from research about beginning the ACO process. Leaders should be able to understand and articulate ACO concepts. They should champion embracing cultural change while partnering with physicians. Inventory of skills and capabilities should take place to understand any deficiencies required to implement an ACO. Finally, a plan should be formed by asking strategic questions on each platform needed to ensure performance and strategic goals are at the forefront of decisions regarding structure and function of an ACO. It takes a visionary leader to accept these challenges.

Risk or reward? Laying the IT foundation for ACOs presents daunting challenges for healthcare leaders nationwide.

Industry experts and healthcare IT leaders agree that the recently released proposed rule on the creation of accountable care organizations (ACOs) is offering a heady mix of opportunity and risk, and that laying the IT foundation for success under ACO initiatives will be massively challenging for the vast majority of patient care organizations nationwide. Those a bit further along on the journey say that interoperability, connectivity, and the leveraging of clinical lT for intensive care management and data analysis will be essential to ACO success.