Medicare Advantage plan representatives' perspectives on Pay for Success.
Am J Manag Care
; 25(11): 561-568, 2019 11.
Article
en En
| MEDLINE
| ID: mdl-31747235
ABSTRACT
OBJECTIVES:
To understand how Medicare Advantage (MA) plan representatives perceive the alternative financing model Pay for Success (PFS) and its potential to address members' social risk factors. STUDYDESIGN:
Semistructured qualitative interviews designed to understand plan representatives' priorities regarding addressing nonmedical needs of their members, awareness of and experiences with PFS, and thoughts about implementing PFS as a method to address members' nonmedical needs.METHODS:
Interviews with 38 upper-management representatives from 17 MA plans, which represent 65% of MA beneficiaries nationally, were conducted from July to November 2018. Plans varied in geographic coverage, star rating, and enrollment. Transcripts were qualitatively analyzed to understand overarching themes and patterns of responses.RESULTS:
MA plan representatives were largely unfamiliar with PFS and were interested in learning more about how it could address members' social needs. When probed about specific requirements of PFS, responses varied Some reported willingness to share data with project partners and be reviewed by independent evaluators; others expressed their preference to keep data and performance analysis internal to the organization. Although most representatives prioritized innovation, some were more risk averse and preferred to use traditional methods to deliver new services.CONCLUSIONS:
MA plan representatives were unfamiliar with PFS, but most expressed interest in it as an alternative model for funding initiatives to address members' social needs. Education of MA representatives about PFS as an alternative payment model for innovative programming is warranted. However, further guidance from CMS is needed to assuage the concerns raised by these representatives.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Personal Administrativo
/
Medicare Part C
/
Determinantes Sociales de la Salud
Tipo de estudio:
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
/
Equity_inequality
Límite:
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Am J Manag Care
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2019
Tipo del documento:
Article