Healthcare Payment Models
CMS has committed to disbursing half of its total payments through value-based payment agreements by 2018, and a private payer alliance has likewise committed to a 75% target for its total payments received by 2020. CMS has demonstrated its commitment with the implementation of mandatory value-based payment through its Comprehensive Care for Joint Replacement initiative and is proposing a similar initiative for selected cardiology procedures. These programs make providers accountable for the cost and quality of care across the acute care episode and the 90 days that follow. Delivery's Response to Increased Risk and Accountability Delivery organizations have pursued multiple strategies in response to their growing accountability for cost and quality. Perhaps the most common tactic is horizontal consolidation. By creating ever-larger systems, providers expect to gain greater control over vendor relationships and obtain more favorable purchasing terms. Delivery organizations also believe that consolidation will strengthen their position when negotiating with payers for reimbursement.
Physician payment & delivery models | American Medical Association
- Healthcare Payment Models (completed) Flashcards | Quizlet
- Patient Driven Payment Model | CMS
- Value-Based Payment Models: Implications for Medical Device Manufactur | mddionline.com
Another method delivery organizations are using to control cost and quality is to experiment with new care models and to leverage technology to lower cost. New care models including accountable care organizations, patient-centered medical homes, and population health management, are designed to incentivize care coordination. Technologies such as telemedicine and remote monitoring extend expertise at lower cost than traditional delivery methods. Delivery organizations are also trying to manage variation in the cost of care by developing and implementing care paths and treatment protocols. Some of these outline general clinical decision points, while others go as far as defining the specific products to be used. As delivery organizations develop better methods for controlling cost and quality, device manufacturers must understand the implications of these changes and how they will affect their business in the future. Product Adoption and Reimbursement is Not Guaranteed In a value-based payment environment, providers will seek products and services that help them reduce variation in average cost per case that does not yield downstream clinical or cost benefits.
