Ramifications for the Healthcare Industry: the Move to Value-Based Reimbursement
With the passage of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, it is clear that the transition from a fee-for-service (FFS) reimbursement model, based on volume, to a fee-for-value (FFV) approach or value-based reimbursement model, based on quality and cost, is well underway. At its core, value-based reimbursement inherently will require providers to manage the health of certain populations of patients, rather than managing the health of one patient at a time (as under the FFS reimbursement system).
With value-based reimbursement linking provider payment to outcomes, providers and payers should be aware of new transaction types and characteristics relevant to value-based reimbursement. Under contemporary models, much of the financial and clinical risk shifts from the payer to the provider and providers are held accountable for leading the care continuum. Providers are rewarded based on the quality and efficiency of the care they deliver, as well as their ability to contain costs.