The shift in healthcare from volume to value has been a long time coming. The goals are two-fold: increase access and decrease cost. By expanding insurance coverage, you get better access and by reforming insurance systems, the hope is lower cost.

But how do you get there? By reforming the delivery system through value-based payment reform.

Fee for Volume vs. Fee for Value

The factors that go into a population’s health—lifestyle, medical access, and environment—combined with the Medicaid expansion, have contributed to the shift.

New payment models have sprouted related to the growth and management of the numerous health conditions in the patient population.

Introducing the MACRA Law

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) law created several new value-based reimbursement programs and included certain policy changes that will greatly accelerate the shift toward value-based payments over the next several years.

There are two new payment systems for physicians to choose from: the Merit-based Incentive Payment System (MIPS) or participation in a qualifying alternative payment model (APM). There’s a lot of uncertainty around which program model will work best and how interoperability and EHR requirements come into play. Check out CMS for more information on MACRA.

The Impact

As part of the MACRA law, Congress declared it a “national objective” to achieve the widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018. In addition, the law stated that by July 1, 2016, and in consultation with private sector stakeholders, the Secretary of Health and Human Services (HHS) will establish metrics to be used to determine if, and to the extent, this objective has been met.

The Road to Payment Reform Webinar Series

Join me and Chris Emper, Director of Government Affairs, for a webinar series where he will discuss the healthcare industry’s shift in payment reform, the federal government’s involvement and impact, what the new payment models mean for healthcare organizations, and which model is right for you.

Sign up for the First in the series: Volume to Value: The Road to Payment Reform {Episode 1}