A big trend in healthcare today is value-based care. Value-based care models seek to improve patient outcome, efficiency and ultimately reduce the overall cost of care. Value-based care is a reimbursement model that may replace the traditional fee for service reimbursement model in the future.
CMS Medicare Services Shared Savings
In an effort to transform how healthcare providers are reimbursed, the Centers for Medicare & Medicaid Services (CMS) has developed several value-based care models, such as the Medicare Shared Savings Program and the Accountable Care Organization (ACO) Model. Many commercial have also adopted similar models of accountable, value-based care.
According to The Center for Medicare and Medicaid Services (CMS) Medicare 2018 Shared Saving Program data, there are 561 organizations participating in CMS approved ACO programs. Financial data for year of 2016 showed a Total Earned Performance Payment of over $700 million dollars. Of those organizations participating in the program, only about 30% are physician only organizations, while almost 60% of all ACO programs are physicians, hospitals and other facilities. Source: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/SSP-2018-Fast-Facts.pdf
Measurable Improvement
Unlike the traditional reimbursement model, value-based care is driven by data. Providers must report to payers on specific metrics and demonstrate improvement. Providers may have to track and report on hospital re-admissions, adverse events, population health, patient engagement, and other important measures. A key aspect of any value-based care model is the ability to show measurable improvements in care, the impact on a patients condition or health and ultimately the reduction of costs.
For many physicians, providing data to support a measurable improvement may not be possible. The ability for small groups or independent physicians to establish a data collection process and method of reporting the data can prove to be difficult and very time consuming. Often, physicians will outsource this process or participate in programs through hospitals or other third party organizations. However, doing this can result in the patients being steered toward other care providers affiliated with the hospitals or third party organizations.
What You Can Do
If joining an existing ACO isn't something you are interested in doing, consider joining an Independent Physician Association (IPA). Many IPA's have preferred carrier contracts that provider a higher rate of reimbursement for the services you are likely already providing. Many of these contracts require participating physicians to share data and follow certain protocols when in comes to services offered, diagnostics and prescription medication choices.
At MDamerica, we work with physicians, self insured organizations and insurance carriers to develop cost savings programs that incentive independent physician participation. For more information about our programs and how we can work together to improve care, reduce healthcare costs and increase your revenue, please email us at: partners@mdamerica.com