Evidence-Informed Case Rates: A New Health Care Payment Model
This study supported by The Commonwealth Fund examines a new payment model using evidence-informed case rates (ECRs) paid to providers for patients with specific conditions. With the help of medical professionals, health care researchers, and data modeling experts, estimate ECRs for 10 different conditions were developed.
Considering prevalence, costs, treatment variation, coordination and reimbursement these groups of experts developed the scope of each ECR. Using hypothetical case examples they determined the resources necessary for providing successful treatment, the length of time it would take to complete this care, who would provide it, and where it would likely be provided. They developed procedures for evaluating provider performance including care process, health outcomes, patient experience, and claims activity tracking care delivered. This payment model is being piloted in a few locations across the country with promising initial results.
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