CIN Resource Page: Managing Total Cost of Care to Succeed in Risk-Based Payment

Reports and tools to support payers and providers


Payment models in California continue to evolve, with a strong trend toward moving more financial risk from purchasers and payers to provider organizations. These resources include information on the payment models in play in California and nationally, and case studies and expert advice on how to succeed in payment relationships that include financial risk.

Resources are organized reverse chronologically and cover the following topics:

Alternative Payment Models and Frameworks

To engage in discussions about payment models, the first step is to understand the landscape: the business relationships, the different payment models, the terminology used, and the interventions that improve the quality of care and ensure financial success in these models.

Advancing Payment Innovation within Federally Qualified Health Centers: Lessons from California
This white paper details best practices in the primary care safety net on a range of payment reform-related issues, including leadership engagement, change management, and financial management. (Center for Health Care Strategies, May 2017)

Success in Payment Reform Requires More and Better Data, Plus a Dose of Experimentation
This report from the California Improvement Network meeting summarizes the discussion of current and anticipated alternative payment models in California, and success factors for each. This is a good starting point for orientation to payment models and the types of changes in population health management it supports. (California Improvement Network, Apr. 2017)

APM Framework Fact Sheet
The fact sheet explains the principles used in the 2017 refresh of this classification system for alternative payment models, and introduces the accompanying white paper, also available for download from the same webpage. (Health Care Payment Learning and Action Network, 2017)

NACHC Payment Reform Readiness Assessment Tool
This assessment tool helps health centers understand their readiness for success in new payment models. This updated version incorporates social determinants of health and IT systems. (JSI Inc., 2018)

Total Cost of Care

Population-based payment can support big changes in the organization of medical care and how care is managed. These resources focus on these opportunities and challenges, with a good mix of case studies from the commercial health care market and the safety net.

Next Phase in Effective Cost Control in Health Care
This article summarizes recent macroeconomic cost trends in health care in the United States, and provides specific recommendations for legal and regulatory strategies to control costs. (Aaron Glickman, Sarah S.P. DiMagno, Ezekiel J. Emanuel, JAMA, Mar. 7, 2019)

How Accountable Care Organizations Use Population Segmentation to Care for High-Need, High-Cost Patients
The payment and care delivery structure of Accountable Care Organizations has contributed to a new focus on the best way to care for patients with high levels of care needs. (Ann S. O’Malley et al., Commonwealth Fund, Jan. 3, 2019)

What is Driving Total Cost of Care?
White paper that analyzes quantitative and qualitative data from different healthcare markets across the United States, to determine the variables in health care costs. (Healthcare Financial Management Assn., Leavitt Partners and McManis Consulting, June 25, 2018)

Maryland All-Payer Model’s Progression to Total Cost of Care: Alignment Strategies for Stakeholders in New Cost Paradigm
Blog post from law firm involved in the first payment model to put a state at full risk for Medicare beneficiaries. The national Center for Medicare and Medicaid Innovation has a role. (Baker Donelson, June 2018)

This History, Evolution, and Future of Medicaid Accountable Care Organizations
This brief highlights results from Medicaid Accountable Care Organizations across the country, as well as key themes and lessons from early adopters. (Rachael Matulis and Jim Lloyd, Center for Health Care Strategies, Feb. 2018)

Healthcare Affordability: Untangling Cost Drivers
Interactive website of multiple resources (white papers, webinar recordings, case studies, and more) to inform action by stakeholders in impacting total cost of care. (Network for Regional Healthcare Improvement, 2018)

Using Cost of Care Data to Achieve the Triple Aim
Direct-download of presentation slides from a California Improvement Network webinar on the measurement of total cost of care, quality improvement drivers for use of these data, and the experience of a safety net provider organization in improving care for their patients with its use. (CIN webinar, Sept. 26, 2016)