Value-based Care Models Gain Momentum

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
Value-based Care Models Gain Momentum

The movement toward value-based care shows no signs of letting up, as evidenced by last month’s official kickoff of the Health Care Payment Learning and Action Network.

Since the network was announced in January by the Department of Health and Human Services (HHS), more than 2,800 entities have signed up, including home care organizations, other providers, payers, employers, states, consumer groups and others. Nearly four dozen participants have announced specific goals related to their participation, including seven states, several hospital systems and payers, along with the nation’s largest private employer, Walmart.

The network is one of many efforts HHS is leading “to drive better care, smarter spending, and healthier people by improving the way care is delivered, the way providers are paid, and the way information is shared to support decision-making.”

I’ve previously mentioned ambitious plans by HHS to shift by 2016 nearly one-third of all Medicare payments to value-based care models that stress quality over volume, continuing an industry shift away from fee-for-volume. By 2018, the agency wants fully half of all Medicare payments flowing to alternative care models. Additionally, for 85% of all payments in 2016 and 90% of all payments in 2018 it is expected that there will be an additional component to the fee- for-service payment that is tied to value.

At the time, I said that many organizations were taking a wait-and-see attitude. However, the number of participants in the action network today tells me that employers, payers and health systems are no longer content to sit on the sidelines.

Regardless of whether your organization is part of a health system or independent, I believe you should be actively searching for ways to participate in these new value-based care models. Although many health systems already participate, home health often gets overlooked in the care continuum – despite the fact you are on the front lines of care.

But it’s no longer enough to talk about the quality of care. You also should understand your organization’s cost structure, including cost per episode, payer types, overhead costs and much more.

With the expectations of care and payments shifting so rapidly, it can be hard to focus on the day-to-day tasks – much less focus longer term. But home health plays a vital role in all of these emerging care models, so make sure your organization has a seat at the table of change.

Are you looking for more ways to stay up-to-date on value-based care models and other industry trends? Visit the McKesson Homecare Talk Resources Center today.

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