Reimbursement

News

Payers Speed-up Push To Value-Based Payment

February 13, 2015

 

The transition from fee-for-service to value-based payment is accelerating, according to recent statements by the Department of Health and Human Services and a group of health providers and commercial insurers.

 

·Medicare

In January, HHS announced a goal of moving 85% of Medicare fee-for-service reimbursement to value-based payment models by 2016 and 90% by 2018. These include Accountable Care Organizations, advanced primary care medical homes, and new models of bundling payments for episodes of care, as well as value-based purchasing for hospitals and physicians. All of these efforts link reimbursement to the quality of care. HHS said the purpose was to help drive the health care system towards greater purchasing of high-value care, rather than continuing to reward volume regardless of the quality delivered.

 

·Private Payers and Providers

Two days after the HHS announcement, a group commercial payers and health systems announced their commitment to put 75% of their business into value-based arrangements by 2020. The group, which included six large health systems and four major health insurers, defined such arrangements as those which create incentives, and hold providers accountable, for total cost and quality of care for specific populations of patients. Payers in the group include Aetna, Blue Cross Blue Shield of Massachusetts, and Health Care Service Corporation; providers include Advocate Health Care, Dartmouth-Hitchcock Health, and Premier. The group asked others providers and insurers to join in.

 

Click to view HHS press release.

Click to view private payers statement.