Embrace Value-Based Reimbursement
The move to value-based care and value-based reimbursement is gaining momentum in healthcare and will only increase over time.
For health plans, this means having the flexibility to negotiate, implement and administer a variety of contracts with providers and offer corresponding benefit plans to members. Sharing risk as well as rewarding providers for improved outcomes and keeping individuals and populations healthy is essential. Effective value-based contracts not only benefit patients –health plans lower medical costs by avoiding costly encounters, services and hospitalizations. There are many models, ranging from simple quality metrics to full capitation, with a full spectrum in between.
Embracing Value-Based Reimbursement and Contracting
Payers, providers, the U.S. government, and other entities have made initial investments in value-based reimbursement. And while these initial investments have, in some cases, made great strides in the march toward quality-based care, costs are still increasing, payers and providers are no closer to a trust-based relationship, and fee-for-service is still a large part of reimbursement.
CMS has been pushing the advancement of value-based payments and care for at least five years, since the passage of the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) bill in 2015. While COVID-19 has interrupted the regulatory momentum for much of 2020, alternate benefits remain a significant emphasis and Social Determinants of Health (SDoH) is also a focus. Health challenges such as food insecurity and isolation have increased significantly with the onset of the pandemic. Another important result of the pandemic has been the interruption of revenue for many providers who relied on preventative and elective medicine/ procedures in Fee for Service arrangements. Many of those providers will be receptive to and potentially looking for value-based arrangements in the future. Health plans not able to adapt for value-based models will find themselves behind the needs of their providers, the dependencies of many members and potentially out of compliance as well. Health plans not able to adapt for value-based models will find themselves behind the needs of their providers, the dependencies of many members and potentially out of compliance as well.
This video demonstrates just a few of the many ways HealthRules Payor supports a health plan’s value-based initiatives.
HealthRules Payor allows health plans to swiftly configure and launch new contract arrangements and benefit plans including value-based arrangements