Is Your Agency Ready for Value-Based Payments?

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
Is Your Agency Ready for Value-Based Payments?

The days of fee-for-service reimbursement appear to be numbered, caught up in lofty Triple Aim goals and the rise of accountable care organizations (ACOs) and alternative payment models.

Is your organization prepared for the changes? Do you have a data analysis solution in place to help you understand the financial metrics of your agency, including payer categories, direct and indirect costs and other factors?

The Department of Health and Human Services in January announced ambitious plans to shift 30% of all Medicare payments by 2016 to alternative payment models that stress care quality over service volumes. By 2018, the payment goal is 50%. According to news reports, most large providers are taking a wait-and-see approach to the announcement.

And have you heard about the Health Care Transformation Task Force? It’s an alliance of six leading health systems and four large payers dedicated to speeding up the transformation of the U.S. healthcare system through value-based practices and clinical models. In an announcement about the alliance, task force members “challenged other providers and payers to join its commitment to put 75 percent of their business into value-based arrangements that focus on the Triple Aim of better health, better care and lower costs by 2020.”

More recently, five Maryland health systems formed an ownership organization of 10 hospitals in response to the state’s “all-payer” reimbursement model that occurred in January 2014. The new payment model is designed to move the state toward value-based payments since reimbursement is based on patient population size.

Although there are hundreds of ACOs in place around the U.S., including 19 so-called “Pioneer ACOs,” their success has yet to be “fully realized,” writes Lea Binder, president and CEO of the Leapfrog Group.

The path away from fee-for-service isn’t following a straight line. Rather, it is meandering one way then another as a better way is sought. But make no doubt about it; your organization should be trying to find the path that works best in your local or regional community.

Read more about the opportunities value-based purchasing and payments can bring to your home health organization.

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