The 'Edge Report Blog

Update: The Undeniable Rise of Value-Based Models

As we discussed in our first post, the proliferation of value-based models is upon us, and the topic is now making its way out of industy circles and into the mainstream. In fact, it was recently described in a Business article appearing in the Boston Globe on April 16, titled “Why is the State Restructuring MassHealth,” referring to the Massachusetts Medicaid program. In the article, it was revealed that MassHealth serves 1.8 million people, represents 40% of the entire Massachusetts state budget, and must completely change its payment model from traditional fee for service to value based payments.

The change does not happen overnight nor is it without ripple effects. As the article states, “Insurance companies, physician groups, hospitals, and other health care organizations will have to adapt to the new payment models. For many health care providers, this means building up care teams and data-crunching technology to better track and coordinate patient care.” With MassHealth payments at $14.7 billion this year and projected to rise, the state of Massachusetts is turning to accountable care and value based models to help the population receive care in a more proactive and coordinated way, and at the same time help the program save money in the long run.

Read the full article here.