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Transitioning payer reimbursement from volume to value

By Claire Thayer, October 20, 2015

Moving away from traditional reimbursement models based on volume to those aligned more closely with outcomes, cost and quality is easier said than done, but has over-whelming industry support.  Earlier this year, Modern Healthcare spoke with committee members of a new Health Care Transformation Task Force (made up of providers, insurers and employers) who pledged collectively to shift 75% of its members' business into contracts with incentives for health outcomes, quality and cost management by January 2020.

The U.S. Department of Health and Human services has jumped on board the value reimbursement trend as well, setting a goal of tying 30% of traditional fee-for-service Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50% of payments to these models by the end of 2018.  A Deloitte study found that 72% of surveyed health executives said that the industry will switch from volume to value. The Case for Value-Based Care was the focus of a recent MCOL infographoid, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

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