Medicare Meets 2016 Goals… EARLY?

April 14, 2016


Value-Based Healthcare Is Moving Quickly

“In January 2015, HHS set big goals to move 30% of Medicare to value-based arrangements by the end of 2016. With 121 new Accountable Care Organizations (ACOs) announced in January, along with higher provider participation than expected in other alternative payment programs, the agency says it has already achieved it.”
 See the full Healthcare Finance article

There has been much talk regarding the “shift from volume to value” in healthcare reimbursement. Rather than blindly paying for the number of procedures performed, Medicare and private payers alike are realizing the fee-for-service model is not sustainable. With the average price of surgery fluctuating drastically throughout all regions, payers realize the model must be adjusted to run more like a business. What this means is that cost of service and quality of the services provided must be very well defined, measured, and managed by healthcare organizations that traditionally only had to focus on increasing volume.

Being ahead of schedule in the transition, HHS is sending a clear message to organizations that the Value-based model will be the way of the future. The Comprehensive Care for Joint Replacement (CJR) is the first mandated version of this transition, but you can count on private payers following suit, as the opportunity to share risk and reduce costs is good business. CJR is not a perfect model, but it is a starting point. Organizations not already involved in value-based reimbursements would be wise to use the CJR as a compass for planning.

Outcomes provide significant opportunities for organizations to plan, execute, and improve performance in value-based models. Contact a member of the CODE team to learn how our clients leverage their outcome data.

See The CJR Simplified Guide

or Schedule a Call with a CODE PRO Expert