Value Based Care

The Healthcare payment model is changing

The evolution to value-based payments is up-ending long existing models of healthcare reimbursement, creating new challenges for healthcare providers and administrators. Instead of healthcare systems and providers being paid solely based upon each individual service provided (fee-for-service), payments are now transitioning to be based upon the value of care delivered (value-based care).

This change is intended to drive improvements to the delivery of care by mandating better care at a lower cost. Those providers who can demonstrate ‘higher care’ at ‘lower cost’ will do well in the new payment models. However, for providers that can’t achieve the required metrics, the financial penalties and lower reimbursements will create a significant financial difficulty.

The transition from the fee-for-service reimbursement model to a model based on value is one of the greatest financial challenges health systems and providers currently face.

New Payment Models

Healthmonix is on the forefront of new value-based payment models, providing insight into the key components of the programs that are being discussed, proposed, and implemented.

Quality Measurement

Most of the value-based payment and penalty models being implemented rely on quality measures. For many years, providers have submitted quality measures for programs such as Physician Quality Reporting System (PQRS) and Meaningful Use (MU). However, in most cases, just submission was enough. The bar is being raised with the assessment of the actual quality metrics against benchmarks and peers. These new value-based models require providers to prove that they’re meeting quality standards and benefitting patients while cutting costs.

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