Transitioning to SecureChoice
• Care delivery teams (CDTs) could be established de novo to receive payments from the UCP—or they could begin under Medicare’s demonstration authority
• Medicare should offer CDTs bundled payments at no less than their current Medicare billings, with commitments not to cut them if there are across-the-board FFS fee cuts, but to increase them with across the board increases.
• Academic medical centers creating CDTs could avoid detailed documentation requirements regarding exactly which faculty member or resident provided services included in the new bundled payments
• The UCP is charged with offering coverage for inpatient and chronic illness to all comers at geographic/demographic-based rates. Eventually it will break-even (after expenses), but some start-up funding will be needed
• Providers of inpatient care wishing to be paid FFS by the UCP will be paid at Medicare rates. Those forming CDTs will be paid based on the costs incurred by the CDTs with above-average outcomes. CDTs are allowed to charge patients or insurers more than the UCP payment.
• Private insurers can buy reinsurance for care needed by their enrollees from the UCP, either just for inpatient episodes or also for chronic illness management.
• The UCP will not pay providers directly for chronic illness management, but instead transfers to health plans (or PIs) on a monthly basis risk-adjusted amounts reflecting the chronic illnesses of their enrollees.
• Insurers buying coverage from the UCP must share claims data with the UCP. Such data, however, should have provider-specific fees masked to reduce anti-trust concerns.
• Employers can continue their current plans, reinsure with the UCP, or convert at any time to a defined contribution model, allowing individuals in a family to pool contributions and buy coverage through PIs.
To move things faster, see Facilitating the Transition