Solutions for the Health Industry

The stakes have just been raised for payers and providers already besieged by a rapidly changing market. In an announcement that reverberated throughout health care as few others have, announced an initiative to make alternative payment the standard for 50% of Medicare reimbursement by 2018.

That's the first time HHS has established goals for alternative payment models for Medicare. HHS wants 30% of fee-for-service payments to be tied to quality or value through ACOs, bundled payment or other by 2016, increasing to 50% of reimbursement by 2018.

Is your organization ready? If not, what must you do to get ready? There are two aspects to the challenge of value-based reimbursement (VBR) readiness. The first involves modernizing health care IT from its current fee-for-service (FFS) basis to one that can support mixed reimbursement models—that is, a complex mix of fee-for-service and value-based models.

FFS isn't going away. It's important to capitalize on your core IT assets while simultaneously extending and transforming your operational model from volume to value. You don't want to create more IT silos. Instead, you need to evolve an integrated system that's capable of efficiently scaling both FFS and VBR.

In addition to an IT focus, there's an industry focus. We counted ten things payers and providers can start working on today that will accelerate their ability to align with value-based design, reimbursement and care. These activities should be considered now because, with this new imperative from CMS, there's simply no time left to delay.

To learn the top 10 ways to align with value-based design, reimbursement and care, download the .

Andrei Gonzales

About the author

Andrei Gonzales, M.D., is director of value-based reimbursement initiatives at Web2pro Health Solutions.

Carolyn Wukitch

About the author

Carolyn J. Wukitch is senior vice president and general manager for network and financial management at Web2pro Health Solutions.

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