The power struggle in HBO’s hit series Game of Thrones has seven kingdoms wrangling over power. While fictional, it is ultimately a story of incentives and how changing them changes behavior – of individuals and of kingdoms.
Incentives are powerful drivers of behavior, and when they change, a Game of Thrones drama always plays out. We see this today as healthcare’s “kingdoms” of physicians, providers, hospitals, drug companies, employers and patients wrestle with the redistribution of money brought on by the CMS Center for Medicare & Medicaid Innovation (the CMS Innovation Center).
Congress created the CMS Innovation Center to test “innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care” for individuals who receive Medicare, Medicaid or Children’s Health Insurance Program (CHIP) benefits.
CMS is moving quickly in testing and measuring new payment and service delivery models. For example, it took only a few years for it to test a voluntary bundle payment program for knee replacement (BPCI) before mandating the model (CJR) for all orthopedic surgeons and their hospitals in 90 communities across the country.
This January, “winter is coming” when the Medicare Access & CHIP Reauthorization Act (MACRA) merges the meaningful use program, the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM) into a single new effort – the Merit-Based Incentive Payment System (MIPS). And then there’s the IMPACT act for bundling post-acute care providers. While the programs these acronyms represent are important, the bigger point is that CMS is changing incentives at a depth and speed we have never before seen. Because CMS is the biggest purchaser of healthcare, its decisions move the market.
Understanding these new and changing programs will always be a challenge. Make sure your organization can support these programs in the Game of Thrones. Collaboration, networking and partnerships are the required tools to win. The siloes of the fee-for-service era are on their way out.