Pillar Chair

Phil Boulter

About the Health Payment Reform Pillar

Our current payment system is at odds with our goals for a reformed health care system.  It fails to adequately incent or support quality and efficiency, and it ignores evidence-based practice and care coordination.  As a result, we have witnessed an erosion of primary care and wellness, a continued, yet unsustainable rate of increase in costs, a deeply fragmented system of care, and a worsening of health status indicators and levels of access. 

In July 2010, the NH Citizens Health Initiative launched a statewide, five-year Accountable Care Organization (ACO) pilot project in an effort to achieve the level of cost and quality performance of the top five “low cost, high quality” states.  Accountable Care Organizations (ACO) assume the primary role and responsibility for a population’s health care, which includes both cost and outcomes. This Pillar Project encompasses the commercial insurance market and includes five delivery systems statewide. It is aligned with the State of NH’s efforts to provide affordable and accessible health care for the citizens of NH.  This ACO pilot project builds on a long-term relationship between The Citizens Health Initiative and several organizations including, but not limited to, the NH Medical Society, the NH Hospital Association, the four private commercial carriers (Anthem Blue Cross Blue Shield of NH, CIGNA HealthCare, Harvard Pilgrim Health Care and MVP Health Care), the NH Department of Health and Human Services, and the NH Department of Insurance.  The participating delivery systems represent a total population of greater than 400,000 individuals of the total 1.3 million NH citizens and 700 of the 3,900 practicing clinicians in the state. The pilot systems were selected through a competitive application process. 

Together, members of the Accountable Care Organization Pilot will re-architect the payment system in New Hampshire to:

• Align payment, goals and incentives across the systems of care: primary, specialty,
  behavioral, ancillary and hospital;
• Align goals and incentives across employers, payers and systems of care;
• Address the unsustainable rate of growth in healthcare expenditures;
• Reward explicitly defined quality care;
• Reward excellence in the delivery of evidence-based clinical practices;
• Incent the use health information technology;
• Recognize administrative best practices and lean processes; and
• Serve as a model of transparency. 

We will achieve this by taking active and immediate steps through transparent collaboration among a diverse group of stakeholders.  We will evaluate a full breadth of payment reform schemes and design pilots that leverage those attributes that best address the Pillar goals and the New Hampshire clinical, public health, market and policy nuances.

For more information on this working group contact Megan Spencer.