A New Way of Thinking

Value based vs volume based. It’s not dissimilar of the old “quality vs quantity” argument. That idea is at at the heart of a shift in thinking around the way medical and health care payments are made.

From Health Affairs Blog:

The Centers for Medicare and Medicaid Services (CMS) is adopting new payment policies that will rapidly shift current reimbursement models that reward volume to alternative models designed to reward value and care coordination. These reforms also expand existing value-based purchasing programs that pay incentives or impose penalties based on performance in selected quality and efficiency measures.

Medicare payment reform has grabbed a lions share of the recent headlines and many people are now familiar with terms like Alternative Payment Models (APM’s) and Merit-Based Incentive Payment System (MIPS). They serve as the cornerstones of the Medicare Access & CHIP Reauthorization Act (MACRA) of 2015 that Congress enacted last year to replace the Sustainable Growth Rate (SGR) formula for physician reimbursement.

According to a recent article in Health Leaders Media,  “MACRA rules are going to play a key role in helping to guide all healthcare providers away from business models structured for fee-for-service medical care to value-based business models, says Melissa Jackson, who also serves as a senior associate director for policy at the American Hospital Association (AHA).”

“We’re seeing shifts in the relationship—where even when physicians are not employed, hospitals and physicians are forming tighter affiliations. So, particularly with the incentives that are embedded in the new physician payment system under MACRA, and the emphasis on the alternative payments models and value-based payment, that helps align incentives across hospitals and physicians.” ~ Melissa Jackson

However, medical and health care payment reform is not tied solely to Medicare. For example, there is a movement in Arizona to change behavioral health payment models….and there are many others.

In an effort to help people better understand the transition from volume-to-value-based healthcare, the Arizona Hospital and Healthcare Association (AzHHA) will be hosting the “Arizona Healthcare Payment Reform Summit” on May 23rd.  This will not only be an opportunity to hear from leaders who represent payers, providers and other constituents of healthcare delivery, the summit will also provide attendees with:

  • An overview of the national perspective of payer-driven risk,
  • Discuss key characteristics of successful integrated care systems and Accountable Care Organizations (ACOs), and
  • Define strategies to effectively prepare and enhance operations under value-based payment.

Click here to sign up or to find more information on the event. Creating and developing these types of programs to help people better understand the changes that are coming in health and health care, will also help us take another step toward our long term goal of making Arizona the Healthiest State in the Nation!


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