Care delivery in the United States is the one of the costliest affairs for the residents of the nation. To put things in perspective, U.S. healthcare costs nearly $2 trillion every year, out of which more than 31% is never presented to the recipients (counts for administration costs). This, undoubtedly calls for an immediate and drastic care transition and Value Based Care (VBC) is a terminology that has been long awaited. The shift from volume-care to value-care is no easier than accepting smart phones/tablets/laptops in replacement of the bulky PCs. This shift from the fee-for-service payment models to value based care compel health systems to blend operational, financial, clinical, and other data to improve quality, control costs and managing provider networks, and providing access. The U.S. Government is building a new payment landscape and creating a new paradigm which undertakes the responsibility of coordinating complete care along with bearing the risks of costs and outcomes.
Value based care has emerged as a successful model with the refinement of information technology and application of strategies to the traditional fee-for-service payment mechanism that ruled the healthcare until lately. Value based care is a highly integrated system and includes the medical Shared Savings Program, value based payments to the hospitals, and others.
Reshaping the healthcare models, a multitude of new payment models have been established, out of which the most important is Value Based Reimbursement (VBR). The Obama Administration introduced and implemented multiple VBR verticals including bundled payments, medical home models, variations of Accountable Care Organizations (ACOs) and special incentives to physicians for care coordination, giving way to many more innovations. The MACRA’s sweeping payment reform provisions comprise of several steps to facilitate providers to participate in Alternative Payment Models (APMs) for initial bonus payments, exemption from MIPS requirements, and are not expected to meet EHR requirements. The healthcare providers participating in APMs are eligible for higher annual payment updates for their fee-for-service revenue stream beginning in 2026. Further, MACRA also establishes a 2-track system for identifying qualifying participants
1) Beginning in 2019, if they receive a significant share of APM revenue in Medicare alone; or
2) Beginning in 2021, if they receive a significant share of APM revenue through Medicare or a combination of Medicare and other payers.
The Department of Health & Human Services (HHS) aims for converting 30 percent of the fee-for-service Medicare payments to value based care models by the end of 2016 and expects 50 percent of traditional payments undergo this care transition by 2018.
Also called as episode based payments, this introduces a single payment for services provided under a complete episode of care. Providers including the hospitals, physicians, settings, surveys, procedures and exercises all come together on a single platform and interact closely to make the medical procedure hassle-free and convenient for both – the providers and patients. This drastically reduces the medical expenditure too.
The VBC initiatives are being appreciated by care-givers, payers, and other stakeholders.
- The Centers for Medicare and Medicaid Services (CMS) estimated a growth at the rate of $10 billion per year for medical reformation efforts like VBC.
- Aetna invested 15 percent of its spending towards VBC efforts and announced to invest up to 45 percent by 2017.
- The Department of Health & Human Services aims at tying 30 percent of their payments to value based care payment models by the end of 2016 and would increase this to 50 percent by 2018.
The government has initiated the care transition and now is the time for some real change in the healthcare spendings of the United States. Life Cycle Health’s initiatives are in compliance with the government’s take on value based care system and our patterns adhere to treating patients with complete satisfaction and at reasonable prices. We designed a platform where all individuals involved in patient care can interact throughout the treatment episode and invest our innovative ideas so that medical care can prosper with the willingness of care-givers and patients. We accept bundled payments so as to calm down the huge medical expenses.
For more info visit :
- Value Care is the New Health Care – United States Government
- Value-based care is changing everything