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Stuart Guterman Vice President, Payment and System Reform

Matching Revenue Flows With Population Needs: The Challenge of Payment Variation Across Providers and Payers and Over Time. Stuart Guterman Vice President, Payment and System Reform Executive Director, Commission on a High Performance Health System The Commonwealth Fund

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Stuart Guterman Vice President, Payment and System Reform

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  1. Matching Revenue Flows With Population Needs:The Challenge of Payment VariationAcross Providers and Payers and Over Time Stuart Guterman Vice President, Payment and System Reform Executive Director, Commission on a High Performance Health System The Commonwealth Fund Alliance for Health Reform Hill Briefing Washington, DC April 13, 2012

  2. Variation in Prices for Colonoscopy, Mammogram and MRI Across Payers and Providers in New Hampshire What Insurance Pays to Health Care Providers Across New Hampshire Per Procedure Source: CMWF analysis of data (July 2011) retrieved at http://www.nhhealthcost.org/costByProcedure.aspx

  3. Potentially Avoidable Hospital Use & Cost Commercially Insured and Medicare Spending per Enrollee, Relative to U.S. Median Spending for each population HRR = hospital referral region DATA: Commercial – 2009 Thomson Reuters MarketScan Database, analysis by M.Chernew, Harvard Medical School. Medicare – 2008 Medicare claims as reported by IOM . Ratio lower than 1.0 indicate percent lower than average; ratio higher than 1.0 indicate percent higher than average. Median spending determined separately for the commercially insured and Medicare populations SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012

  4. Annual Rates of Increase in Hospital Costs per Case and Medicare, Medicaid, and Private Payment Rates, 1988-2008 Source: Commonwealth Fund analysis of American Hospital Association Annual Survey data.

  5. Today’s Panelists • Steven Safyer, M.D.—President and CEO of Montefiore Medical Center, New York, NY • Gregory Reicks, D.O.—President, Mesa County Physicians IPA, Grand Junction, CO • John Colmers—Chairman, Maryland Health Services Cost Review Commission • Jim Bentley-Health Policy Consultant, Silver Spring, Maryland

  6. Questions for the Panel • How do you match the flows of revenue from different sources with the needs of the population to be served? • Medicare, Medicaid, privately insured? • The uninsured? • How do you deal with the changes over time in the flows of revenue from different sources? • What lessons can be learned from your experience that could be applied to other areas/circumstances? • What implications does your experience have for federal policy?

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