Care delivery in the United States is the one of
the costliest affairs for the residents of the nation. To put things in
perspective, U.S. healthcare costs nearly $2 trillion every year, out of which
more than 31% is never presented to the recipients (counts for administration
costs). This, undoubtedly calls for an immediate and drastic care transition
and Value Based Care (VBC) is a terminology that has been long awaited. The
shift from volume-care to value-care is no easier than accepting smart phones/tablets/laptops
in replacement of the bulky PCs. This shift from the fee-for-service payment
models to value based care compel health systems to blend operational,
financial, clinical, and other data to improve quality, control costs and
managing provider networks, and providing access. The U.S. Government is
building a new payment landscape and creating a new paradigm which undertakes
the responsibility of coordinating complete care along with bearing the risks
of costs and outcomes.
Value care has emerged as a successful model with the refinement of information technology and application of strategies to the traditional fee-for-service payment mechanism that ruled the healthcare until lately. Value Care is a highly integrated system and includes the medical Shared Savings Program, value based payments to the hospitals, and others.
Reshaping the healthcare models, a multitude of
new payment models have been established, out of which the most important is Value
Based Reimbursement (VBR). The Obama Administration introduced and implemented
multiple VBR verticals including bundled payments, medical home models,
variations of Accountable Care Organizations (ACOs) and special incentives to
physicians for care coordination, giving way to many more innovations. The
MACRA’s sweeping payment reform provisions comprise of several steps to
facilitate providers to participate in Alternative Payment Models (APMs) for
initial bonus payments, exemption from MIPS requirements, and are not expected
to meet EHR requirements. The healthcare providers participating in APMs are
eligible for higher annual payment updates for their fee-for-service revenue
stream beginning in 2026.
Further, MACRA also establishes a 2-track system for
identifying qualifying participants
1) Beginning in 2019, if they receive a
significant share of APM revenue in Medicare alone; or
2) Beginning in 2021, if they receive a
significant share of APM revenue through Medicare or a combination of Medicare and
other payers.
The Department of Health & Human Services
(HHS) aims for converting 30 percent of the fee-for-service Medicare payments
to value based care models by the end of 2016 and expects 50 percent of
traditional payments undergo this care transition by 2018.
Bundled Payments
Also called as episode based payments, this
introduces a single payment for services provided under a complete episode of
care. Providers including the hospitals, physicians, settings, surveys, procedures
and exercises all come together on a single platform and interact closely to
make the medical procedure hassle-free and convenient for both – the providers
and patients. This drastically reduces the medical expenditure too.
The VBC initiatives are being appreciated by
care-givers, payers, and other stakeholders.
· The Centers for Medicare and Medicaid Services (CMS)
estimated a growth at the rate of $10 billion per year for medical reformation
efforts like VBC.
· Aetna invested 15 percent of its spending towards VBC efforts
and announced to invest up to 45 percent by 2017.
· The Department of Health & Human Services aims at tying
30 percent of their payments to value care payment models by the end of 2016
and would increase this to 50 percent by 2018.
The government has
initiated the care transition and now is the time for some real change in the
healthcare spendings of the United States. Life Cycle Health’s initiatives are
in compliance with the government’s take on value based care system and our
patterns adhere to treating patients with complete satisfaction and at
reasonable prices. We designed a platform where all individuals involved in
patient care can interact throughout the treatment episode and invest our
innovative ideas so that medical care can prosper with the willingness of
care-givers and patients. We accept bundled payments so as to calm down the
huge medical expenses.
