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Health Care Delivery Models

Innovation in Home CareTime for a New Payment Model

Educational Objective
To understand how payment models need to change in the post-COVID-19 world

1 Credit CME

JAMA

Published Online: May 21, 2020

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Article Information and Disclosures

Kevin G. Volpp, MD, PhD^1,2,3;

Susan M. Diamond, CPA⁴;

William H. Shrank, MD, MSHS⁴

Author Affiliations

¹Philadelphia VA Medical Center, Philadelphia, Pennsylvania
²Perelman School of Medicine, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
³Wharton School, Department of Health Care Management, University of Pennsylvania, Philadelphia
⁴Humana Inc, Louisville, Kentucky

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Much of the greatest innovation in industries other than health care deploys technology-enabled approaches to making services more accessible and convenient and lower cost or higher quality. For example, companies such as Blockbuster Video, which provided what seemed like essential services, was supplanted by Netflix, which offered on-demand, personalized viewing of videos from the convenience of home. Uber and Lyft have become quite popular, replacing hailing a taxicab. Similarly, in health care there has been a shift toward provision of home services, with substantial growth in areas such as provision of home infusion therapy and remote monitoring of blood glucose levels. The current coronavirus disease 2019 (COVID-19) pandemic has accelerated this shift because care in the home can reduce exposure to potentially infected individuals and help address capacity constraints in health care facilities. However, a common concern has been that payment models have not supported this type of innovation.

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Article Information

Corresponding Author: Kevin G. Volpp, MD, PhD, Perelman School of Medicine, Department of Medical Ethics and Health Policy, University of Pennsylvania, 423 Guardian Dr, 1120 Blockley Hall, Philadelphia, PA 19104-6021 (volpp70@wharton.upenn.edu).

Published Online: May 21, 2020. doi:10.1001/jama.2020.1036

Conflict of Interest Disclosures: Dr Volpp reported receiving grants from Humana during the conduct of the study and grants from Vitality/Discovery, WW (Weight Watchers), Humana, Hawaii Medical Services Association, and Oscar; personal fees from the Center for Corporate Innovation; and personal fees from and being the co-owner of VAL Health outside the submitted work. No other disclosures were reported.

Funding/Support: Supported by a grant from Humana to the University of Pennsylvania.

Role of the Funder/Sponsor: The funder had no role in the preparation, review, or approval of the manuscript or decision to submit it for publication.

References

Shinkman R . Is “empowered dialysis” the key to better outcomes? NEJM Catalyst. March 15, 2018. Accessed May 18, 2020. https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0232

Asch D , Terwiesch C , Volpp KG . How to reduce primary care doctors' workloads while improving care. Harvard Business Review. November 13, 2017. Accessed May 14, 2020. https://hbr.org/2017/11/how-to-reduce-primary-care-doctors-workloads-while-improving-care

Pryor K , Volpp K. Deployment of preventive interventions: time for a paradigm shift. 2018;378(19):1761-1763. PubMed

Volpp KG , Krumholz HM , Asch DA . Mass customization for population health. JAMA Cardiol. 2018;3(5):363-364.PubMed Google Scholar Crossref

Navathe AS , Emanuel EJ , Bond A , et al. Association between the implementation of a population-based primary care payment system and achievement on quality measures in Hawaii. JAMA. 2019;322(1):57-68.PubMed Google Scholar Crossref

Emanuel EJ , Ubel PA , Kessler JB , et al. Using behavioral economics to design physician incentives that deliver high-value care. Ann Intern Med. 2016;164(2):114-119. doi:10.7326/M15-1330 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.