Reform Primary Care Payment
HTI, Embedded Healthcare (a spinoff company now part of Clarify Health), and a major, not-for-profit insurer have developed a capitated payment model for primary care services as the next evolution of value-based payment programs. Using behavioral economic design principles, HTI developed a new capitated payment model with physician feedback as well as financial incentives and physician performance reports. The question is whether this intervention improved quality and/or lowered costs.
HTI is collaborating with our partnering insurer to test, validate, refine and optimize behavioral economics-based design elements in their capitation model. Together, we aim to improve the patient experience, reduce costs, improve outcomes, and support primary care providers.
HTI is providing advanced predictive and statistical analysis to derive member-level adjustments to the capitated per-member-per-month payment amount in order to ensure payments are accurate, adequately account for member risk and other drivers of increased primary care spend, and incorporate behavioral incentives to reward high performers and motivate all participants. Only a year in, this collaboration showed promising improvements in quality measures.