The health care reimbursement landscape continues to change. Both governmental and private payers are trying to move away from traditional fee-for-service (FFS) payment models that reimburse pursuant to the number of services provided to those that reimburse based on quality or value. The Affordable Care Act established tools such as the Medicare Shared Savings Program and the Center for Medicare and Medicaid Innovation whose combined focus is utilizing alternative, value-based payment models that seek to achieve better care, smarter spending and healthier people.
Attempts to transition to these new payment models are underway. The Department of Health and Human Services (HHS) — for the first time in the history of Medicare — announced in January 2015 the following explicit goals:
- Having 30 percent of all FFS Medicare payments made via alternative payment models by year end 2016; and,
- Increasing that percentage to 50 percent by the end of 2018.
HHS reached its first goal almost a year ahead of schedule. Increased participation in accountable care organizations (ACOs) and the creation of bundled payment models — are two examples of these alternative value-based payment models.