HHS Announces Timetable, Goals for Medicare Value-Based Reimbursement

For the first time in Medicare history, HHS announced explicit deadlines and goals for alternative payment models and value-based payments.

According to the newly released announcement, Medicare’s timeline for moving Medicare payments from volume- to value-based is as follows:

  • HHS will tie 30 percent of traditional or fee-for-service (FFS) Medicare payments to quality or value through alternative payment models by the end of 2016. Alternative payment formulas include accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and bundled payment arrangements for episodes of care, which CMS has tested in a range of pilots in recent years.
  • HHS will tie 50 percent of payments to these models by the end of 2018. In 2011, Medicare made almost no payments to providers through alternative payment models, but today such payments represent approximately 20 percent of Medicare payments.
  • HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs.

To make these goals scalable beyond Medicare, HHS will create a Health Care Payment Learning and Action Network. HHS will work with private payors, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs. HHS will intensify its work with states and private payors to support adoption of alternative payments models through their own aligned work, sometimes even exceeding the goals set for Medicare.

Following this announcement, the Health Care Transformation Task Force, whose members include six of the nation’s top 15 health systems and four of the top 25 health insurers, was formed, and challenged other providers and payors to join its commitment to put 75 percent of their business into value-based arrangements that focus on the Triple Aim of better health, better care and lower costs by 2020.

Source: HHS, January 26, 2015

Aligning Value-Based Reimbursement with Physician Practice Transformation

Aligning Value-Based Reimbursement with Physician Practice Transformation a 45-minute webinar on October 24th, now available for replay, Schilz shares the key features of WellPoint’s transformation initiative, including results from its pilot program that have led to a system-wide rollout.

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