Better Care. Smarter Spending. Healthier People.
Paying for Value – Not Volume!
Whether you
are a patient, a provider, a health plan or a taxpayer it is in our common
interest to build a healthcare delivery system that is better, smarter and
healthier – a system that delivers better
care; a system that spends
healthcare dollars more wisely; and a system that makes our communities healthier! We must develop and implement better ways as
a country to deliver care, pay providers and distribute information.
Improving
the quality and affordability of care for all Americans has always been a
pillar of the Affordable Care Act, alongside expanding access to such
care. The ACA provides an opportunity to
shape healthcare delivery, improve the quality of care provided and reduce
overall growth of healthcare costs. Value and care-coordination will now be
rewarded, rather than volume and care duplication. The Department of Health and Human Services
has established and communicated the benchmarks and metrics that will be used
for accountability and drive the attainment of goals for Value Based
Purchasing.
There are
actually four categories that currently outline this new structure for payments
to providers:
1. Category One – fee-for-service with
NO link of payment to quality.
2. Category Two – fee-for-service with a
link of payment to quality.
3. Category Three – alternative payment
models built on fee-for-service architecture.
4. Category Four – population-based
payment.
Value-based
purchasing includes payments made in categories 2 thru 4, with the goal of
moving the majority of encounters to the population-based payment group. The goal is to increase accountability for
both quality and total cost of the care provided. At the end of 2014, an estimated 20 percent of
Medicare reimbursements had shifted to categories 3 and 4.
The
Department of Health and Human Services has set a goal that by the end of 2016, 30 percent of all Medicare
payments will be in categories 3 and 4, and that goal increases to 50 percent
by the end of 2018. Part of this will be
accomplished by utilization of alternative
payments models such as the medical home, bundling payments and utilization
of Accountable Care Organizations. Ultimately the goal is that by the end of 2018, 90 percent of Medicare fee-for-service payments will be in
categories 2 thru 4. In these
alternative payment models, providers are accountable
for the quality and cost of care for the people and populations they serve
moving away from the old way of doing things which amounted to “the more you
do, the more you get paid”.
Let’s expand
a bit on one of the alternative models.
In the Patient Centered Medical
Home model, instead of physicians working in silos, separately, care
coordinators oversee all the care a patient is getting. This means patients are more likely to get
the right tests and medications rather than getting duplicated tests,
procedures, etc. These medical homes
typically offer patients access to a physician or other clinicians 24/7, and
some may offer extended office hours.
According to
the Secretary of the Department of Health and Human Services in a statement
earlier this year, she stated the progress made thus far has saved taxpayers more than $116 billion.
This savings translates in the ability of organizations to reduce expenditures
and reinvest those dollars in higher
quality care for their employees – wellness programs, for example.
America’s
healthcare system is poised to move into its next phase – a coordinated,
cost-efficient and quality driven system that promotes and supports individuals
and community health.
New drivers
have been implemented to foster these changes and next month we will share
information on The Center for Medicare
and Medicaid Innovation, Transforming Clinical Practices Initiative and the
National Quality Strategy.
