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Health Care Researchers Publish on the Implications of New Provider Payment Models on Innovative Medical Technology

Analysis Group Senior Advisor Genia Long and Vice President Richard Mortimer published a peer-reviewed study examining the implications of new provider payment models and evidence requirements that are being used by a growing number of private insurers. The study, “Evolving Provider Payment Models and Patient Access to Innovative Medical Technology” (Journal of Medical Economics, October 8, 2014), which was funded by the Advanced Medical Technology Association (AdvaMed), examines “the evolving use and expected impact of pay-for-performance (P4P) and risk-based provider reimbursement on patient access to innovative medical technology.” Based on information gathered from structured interviews with nine leading private insurers that represent more than 110 million lives, the study found that the use of P4P models and risk-sharing programs has risen and is expected to continue to rise in the near term.

The study suggests that the increased provider financial pressure associated with these payment models could have unintended consequences. The study notes that increased use of P4P and risk-sharing payment models could challenge established medical technology adoption modes, in which “payers assumed a ‘gatekeeping’ role and providers a countervailing patient advocacy role with regard to access to new technology. Increased provider financial risk may result in an additional hurdle to the adoption of new technology, rather than substitution of provider- for payer-based gatekeeping.”

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Across the health care industry, companies are responding to a new landscape defined by such initiatives as personalized medicine and comparative effectiveness research, as well as increased attention to risk mitigation and risk sharing, and evolving regulation. Analysis Group has developed a deep understanding of the health care sector: its unique institutional structure and market dynamics and the most critical business and regulatory challenges facing health care organizations.

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