Build it and they will come (especially when there are few options)

They said “it was coming,” and it did. They said “there’s no turning back” and it appears that they were right. So who are they? Health reform in general is the big “they.” However, more specifically, you can now include The Affordable Care Act, CMS, HHS, ONC, and in addition, most all of the large private commercial payers. Accountable care and the associated new payment models are here to stay. While it may be tempting to try to maintain the fee-for-service status quo, opting out of value-based systems seems unlikely, unless providers are willing to accept lower reimbursements and/or penalties, which both result in decreased practice revenue.

Outcomes will drive incomes

Value-based care models are built upon improving clinical outcomes through effective population health management, while reducing the cost of providing care. One of the goals for doing this is to reduce avoidable hospital admissions and readmissions, as well as provide viable alternatives to emergency room visits.

Earlier this year, The Centers for Medicare & Medicaid Services (CMS) said by the end of 2018, one-half of all Medicare dollars will be paid to doctors and hospitals via “alternative” reimbursement models such as bundled payments and accountable care organizations (ACOs) that incorporate hospitals, surgical care, and outpatient rehab.

According to the department of Health and Human Services (HHS), “Alignment between HHS, private sector payers, employers, providers, and consumers will help healthcare providers to transition more quickly from pure fee-for-service to alternative payment models.”

Value-based Goals Overview

  • Improve clinical quality
  • Address misuse of services
  • Deliver patient-centered care
  • Improve patient safety
  • Avoid unnecessary costs
  • Reengineer care processes and system-wide workflows
  • Make performance results transparent
  • Reduce existing care disparities within your population

An interesting article on the Healthcare Financial Management Association’s (HFMA) website illustrates some of the benefits and the penalties associated with specific value-based payment models.

Powerful clinical data and tools to support population health

There are a number of pay for performance models, including various risk-sharing and capitation arrangements, gain-sharing programs, and risk-adjusted care. At the root of these programs is effective population health and care management. NextGen Care™ is our fully integrated population health and collaborative care management solution. It provides our clients with the tools they need to more easily manage their patient populations; and to track, measure, and report on clinical outcomes and meet quality measures that align with the new value-based payment system.

The “devil’s in the details,” so learn more

There are several value-based payment models designed to help providers adopt the best arrangement for their particular practice. To learn more about value-based payment models, download our new eBook: The Definitive Guide to Value-Based Care.