At its core, Value-Based Care seems like a no-brainer for the healthcare industry. Simply put, this model rewards providers with incentives based on the quality of the care they provide and outcomes of their patients. Unlike fee for service where providers are paid based on quantity, this alternative model provides cost saving opportunities such as reduced readmissions, improved preventative care, and helps encourage organizations to address important barriers such as social determinates of health (SDOH).
The Centers for Medicare & Medicaid Services (CMS) started leading the charge to a Value-Based Landscape as early as 2008.
Value-Based Programs
Legislation
ACA: Affordable Care Act
MACRA: the Medicare Access & CHIP Reauthorization Act of 2015
MIPPA: Medicare Improvements for Patients & Providers Act
PAMA: Protecting Access to Medicare Act
Program
APMs: Alternative Payment Models
ESRD-QIP: End-Stage Renal Disease Quality Incentive Program
HACRP: Hospital-Acquired Condition Reduction Program
HRRP: Hospital Readmissions Reduction Program
HVBP: Hospital Value-Based Purchasing Program
MIPS: Merit-Based Incentive Payment System
VM: Value Modifier or Physician Value-Based Modifier (PVBM)
SNFVBP: Skilled Nursing Facility Value-Based Purchasing Program
Information from: www.cms.gov
So what is holding Value-Based Care back? Increased regulatory pressure and complexities of shared savings programs can create administrative burdens. Many payers and providers find these programs difficult to implement and sustain.
While many healthcare executives may feel a bit like Sisyphus when it comes to Value-Based-Programs, there is hope and this model can be successfully applied. As many Accountable Care Organizations (ACOs) have demonstrated, the right care at the right time has proven results in reducing costs while increasing quality of care. This transition can be daunting and HCIM’s team of healthcare executives are here to help guide you with a tailored approach. This collaboration through evaluation, planning, implementation, and execution ensures that milestones are met, and the established vision becomes a reality.
Contact us today to learn more.
