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  • Value-Based Payment & Delivery Models

     

     Value Based Purchasing Image

    The cost of healthcare has led policy makers to rethink how care is delivered and providers are paid. Fee-for-service payments are likely to continue their decline as we transition towards a value driven healthcare system that rewards high quality and cost effective patient care. Established under authority of the Affordable Care Act (ACA), the Center for Medicare and Medicaid Innovation will play a central role in this transition by testing and implementing payment models that demonstrate quality improvements and cost savings.

    The following resources provide information about some of these payment models that are focused on encouraging high value care delivery through greater integration, improved care coordination, and a focus on patient safety. These models are designed to foster a culture of accountability that rewards high quality and cost effective care.

    Accountable Care Organizations and Medicare's Shared Savings Program

    Accountable Care Organizations are legal entities which are designed to allow integrated networks of providers that improve patient outcomes and lower costs to share in the savings that come from more coordinated care.

    Value-Based Payment Modifier for Physicians

    Provides information on Medicare's plans to confidentially and publicly report physicians' cost and quality of care and to implement a physician pay-for-performance program.

    Hospital Value-Based Purchasing Program

    A pay-for-performance program that links a percentage of hospitals' Medicare payments to their performance or improvement on certain measures.

    Hospital Re-admissions Payment Policy

    Reduces hospitals' payments based on their percentage of potentially preventable Medicare re-admissions for certain high volume and cost conditions for which their are risk-adjusted re-admission measures.  

    Hospital-Acquired Conditions Payment Policies

    Describes Medicare's current Hospital-Acquired Conditions payment policy and plans to implement future payment adjustments for conditions acquired in the hospital and alternate setting.

     

     

 

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