While there is much debate going on in Washington, DC, as to the fate of the Affordable Care Act (ACA) given the new administration in power, the transition from volume-based to value-based care stems back long before this transfer of power. This “movement” was set in place even prior to the Obama administration taking office and is expected to continue. All post-acute providers - home health agencies, hospices, and skilled nursing facilities - need a proactive strategic plan to be successful with value-based care.
The US has the most expensive healthcare system in the world but ranks an abysmal 37th in terms of performance according to WHO. Healthcare represents 18% of the US economy with further increases projected. The bottom line is that medical spending is unsustainable at the current trajectory with volume based reimbursements.
Health and Human Services noted this pattern years ago and charged its Centers for Medicare and Medicaid (CMS) to explore more sustainable options. This value-based movement, independent from the ACA, incentivizes providers for higher quality of care instead of sheer quantity as in a volume-based system. CMS has been blazing the trail with a long list of demonstration projects. Successful projects are then rolled out to healthcare marketplace. The chart below, provided by the CMS, depicts the progression of initiatives over time.
CMS set aggressive goals for the adoption of these alternative care delivery and payment models - Accountable Care Organizations (ACO), Bundled Payments, Patient Centered Medical Homes, etc. Late last year, CMS reported that they were ahead of schedule, meeting their goal of tying 30% of Medicare reimbursements to quality or value through alternative payment models. By 2018, CMS has set the bar at 50%.
While most healthcare analysts believe that the ACA or core parts of the ACA will be repealed, all are confident that the shift to value is here to stay.
Likewise, commercial payers are following CMS’s lead in transitioning to value-based care. Programs that mimic CMS programs like ACOs and bundled payments have appeared and are gaining traction. Post-acute providers should continue to move along the path to value by:
Focusing on performance metrics - providers will be judged on these metrics
Clinical quality - star ratings, hospitalization and ED visits rates
Costs per patient
Forming or aligning with networks of healthcare providers - alternative payment models will drive capitated payments across provider settings. Networks will be selective in their partnerships, choosing providers with excellent publicly reported outcomes.
Leveraging technology to improve efficiencies, lower costs, and improve quality of care
Maximizing data capture and analysis - data driven decision making is one essential key to success.
At Corstrata’s foundation is the commitment to value-driven wound care. Through secure technology, we provide 24/7 access to wound care specialists to deliver evidence-based, best practice wound care prevention and treatment guidelines. By providing the right care, at the right time, and in the right place, Corstrata improves wound healing times, reduces wound associated supply costs, and reduces the frequency of wound dressing changes.