Thursday, February 19, 2015

Article on Medicare Alternative Payment Models

Medicare Unveils Alternative Payment Models

Find the source article here: Christopher Cheney, for HealthLeaders Media , January 27, 2015 -

Here is the summary:
HHS officials highlight a three-year payment reform timeline, which calls for boosting fee-for-service Medicare reimbursements and increasing reimbursements linked to quality and value.

Federal officials have announced an accelerated effort to use payment reform as a mechanism to shift Medicare and the broader healthcare industry away from the fee-for-service model.

3-Year Timeline

A three-year payment reform timeline is expected to 1) boost the percentage of fee-for-service Medicare reimbursements based on alternative payment models (APM) and 2) to increase the percentage of all reimbursements linked to quality and value.

In the early phase of the payment reform initiative's implementation, APMs will be limited to three pathways: Medicare's existing accountable care organization efforts, the Pioneer ACO program and the Medicare Shared Savings Program; bundled payments; and payment models tied to patient-centered medical homes.

More ambitious value-based payment models are in the works, including episode-of-care payment for chronic illnesses and oncology care that will require providers to shoulder a significant level of cost risk.

The metrics are reported as follows -
The reform initiative calls for Medicare fee-for-service payments through APMs to rise from the current 20% level to 30% by the end of 2016. The percentage is slated to rise to 50% by the end of 2018.

It additionally calls for the percentage of Medicare payments that are linked to quality and value to reach 85% by 2016 and 90% by 2018. Existing Medicare quality and value linked payment programs include the Hospital Value-Based Purchasing (VBP) program and the Hospital Readmission Reduction Program (HRRP).

Marrying Value-Based Care Delivery With Value-Based Payment

HHS officials started foreshadowing the Medicare payment reform initiative in the fall.

In November, the Centers for Medicare & Medicaid Services released details about developing and optimizing APMs, linking fee-for-service payments to quality and value, Medicare ACO and bundled payment projects, and PCMH models.
A primary goal of the Medicare payment reform initiative is to develop and enhance the alignment between value-based healthcare delivery and value-based healthcare payment models.

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