Value-based reimbursement implementation can reduce cost. But due to lack of data access, risk based products and no standardization delays this process.
Spending in US in healthcare is unsustainable. National healthcare cost to total $6 trillion by 2027 predicted by CMS, also the accounts total 19 percent of gross domestic product.
Value based reimbursement is helpful for stakeholders to bend the healthcare cost curve and improve outcomes for the aging population.
Value-based reimbursement ties payments to quality rather than quantity. Healthcare organizations are always trying to improve quality year over year. These organization successes are totally depending on their future view of quality measures otherwise they might fail progress.
Healthcare organization’s staff should have correct tools to manage alternative payment models to ensure of implementation of Value-based care model.
Value-based purchasing is ready to change as part of the Affordable Care Act, but the federal government recently set more aggressive goals for shifting healthcare payments away from fee-for-service payment structures.
Private payers may be lagging behind Health & Human Services with connecting more healthcare payments to value-based purchasing models, but the private sector is following the federal government’s lead. One-quarter of healthcare payments made through commercial. Medicare Advantage, and Medicaid health plans, was paid via an alternative payment model with population-based accountability in 2016. Reported by – The Healthcare Payment Learning & Action Network in October 2016.
MACRA programs expect to shift Medicare providers to value-based reimbursement. However, The Centers for Medicare & Medicaid Services was concerned about the transition away from fee-for-service may be negative impact on small practices and solo practitioners.
MIPS exclusions to advance value-based reimbursement implementation may not be permitted by Congress. Policymakers should also create policies that promote Advanced APM (Alternative Payment Models) participation to actually move providers to new models that successfully reduce costs and improve outcomes through financial risk. AMGA highlighted value-based reimbursement challenges in the commercial market, they also pointed public payers. AMGA criticized CMS’s implementation of MACRA. This is the landmark regulation that created on the Merit-Based Payment Incentive System (MIPS) and APM.
AMGA realised that the value-based reimbursement implementation is the key to reducing healthcare costs across the industry. The association also called for regulatory relief, patient engagement, and care delivery innovation as other ways to reduce healthcare expenditure.