The organization is launching an effort to develop a standard method for employers to evaluate which health payment reforms are most effective, said Andrea Caballero, a program director for Catalyst. “They're being bombarded,” as health plans market new payment models.
Delbanco said the effort will seek to identify measures that reveal the greatest areas of variation in quality and cost.
The survey showed limited use of accountable care, a payment model that gained significant visibility and traction when it was introduced in Medicare under the Patient Protection and Affordable Care Act. Roughly 3% of private health plan spending this year is under accountable care contracts, the survey found.
Notably, the most common incentive in the survey was capitation, or lump sum payments to cover patients' monthly medical bills. Capitation is the riskiest incentive for providers, who must absorb losses when medical bills exceed the lump sum payments. Capitation contracts accounted for 15% of health plans' health spending. A limited form of capitation accounted for another 1.6%.
Dr. Robert Berenson, a Catalyst board member and a senior fellow with the Urban Institute, said he was favorably impressed by the limited use of accountable care and the greater use of capitation. Accountable care typically offers providers a small and delayed financial incentive to change wasteful behavior, he said, whereas capitation creates a significant risk of loss for providers.