Value-Based, 3-Phase Payment Model May Improve HCV Care Coordination

Hepatitis C virus (HCV) infection care coordination with a 3-phase payment model provides an economically-feasible course of treatment at under $95 per participants per month, according to study results published in the Journal of Public Health Management & Practice.

This intervention provides monetary incentives in the form of a bonus payment for organizations that successfully treat HCV, which can empower more primary care providers to treat their own patients with HCV.

The researchers performed an economic evaluation of an HCV care coordination program using micro-costing methods compared with macro-costing methods. They calculated potential payment models for 3 phases: enrollment to treatment initiation, treatment initiation to treatment completion, and a bonus payment for laboratory evidence of sustained viral response. The researchers focused on 2 New York City healthcare provider organizations and interviewed care coordinators and peer educators about time spent on services.

The results indicated that the average cost per participant was $787 ($522 non-overhead cost, $264 overhead cost) per episode of care (5.6 months) at one organization compared with $656 ($429 non-overhead cost, $227 overhead cost) per episode of care (5.7 months) at the other.

The first organization had a lower macro- than micro-costing estimate ($561 vs $787, respectively), whereas the second organization had a higher macro- and lower micro-costing estimate ($775 vs $656, respectively).

With the 3-phase payment model, the researchers found that phase 1 reimbursement varied from approximately $280 to $400 in the two organizations. However, both organizations received approximately the same reimbursement for phases 2 and 3 ($220 and $185, respectively).

“At a cost of less than $800 per participant per episode of care, or less than $95 per month, further evaluation of payment models such as the 3-phase model should be pursued,” the researchers wrote.

Reference

Behrends CN, Eggman AA, Gutkind S, et al. A cost reimbursement model for hepatitis C treatment care coordination. [published online July 2, 2018]. J Public Health Manag Pract. doi:10.1097/PHH.0000000000000806.