Value-based Payment | HAP

HAP

Login to view your account.

Don't have an account? Click here.

Initiatives

Value-based Payment | Shifting from Volume to Value

Value-based payment vs fee-for-service

Fee-for-service is a model where health care providers are reimbursed for services rendered to the patient. This traditional payment model reimburses the provider for each treatment or test provided to the patient. This method has been criticized as rewarding providers for quantity of care versus focusing on quality of care. Providers are incentivized to order more tests and provide more procedures.

Value-based payment is a newer approach aimed at controlling the rising cost of health care and focusing on the quality of care provided to the patient. Where fee-for-service reimburses provides for each health care service provided, value-based care zeros in on the positive outcome of the patient’s treatment. Increased coordination between different providers reduced costly duplication of service and ensures that patient receive the highest quality of care.

The transition to value-based-payment

Currently, the majority of payments to a provider occur in a fee-for-service environment—only a small portion of reimbursements are value-based. The shift to value-based payment is needed to address the unsustainable increase in health care costs. This strategy is being adopted by public and private payers alike and will continue to become the approach of choice. Hospitals will need to think outside of the traditional walls of inpatient care and focus on the entire continuum of care for a population.

Forging the path from volume to value

HAP continues to ensure that the move to a value-based payment approach improves patient care in a sustainable and efficient manner. In 2015, HAP hosted the first annual Payment Reform Summit. This forum brought together hospital leaders from across the state in addition to government officials and industry experts. During the summit, three reoccurring themes were identified as priorities in the shift to value-based care:

  1. Promote changes to existing regulations and policies that prohibit hospitals and providers from taking steps to implement value-based purchasing and otherwise innovate in ways that will allow providers to implement novel programs and assume risk
  2. Promote timely access and transparency to information
  3. Work with the state and federal governments and commercial payers to develop a common platform of metrics, as well as consistency in reporting requirements, areas of clinical focus and value-based program design

Value-based care delivery models

As hospitals and other health care providers begin the shift to value-based care, there are several delivery models that have been developed.

Bundled Payment/Episode of Care is a strategy where hospitals and care providers are reimbursed a predetermined amount based on the procedure performed on the condition diagnosed. This approach provides financial incentives to hospitals to improve efficiency in treatments and reducing unnecessary episodes of care. Bundled payments promotes price transparency, allowing the patient to know how much a procedure may cost upfront instead of waiting until after the produce is complete.

Conversation

Resources

Pennsylvania's Use of Value-Based Payment 2017
HAP’s first value-based payment (VBP) survey report provides insight into how hospitals and health systems in Pennsylvania are transforming to VBP models.

Ask HAP

Related News

Health Care Stakeholders and Payors Weigh in on Future of Value-based Payment by jkissinger@haponline.org

A recently released survey indicates nearly two-thirds of responding health care stakeholders and payors believe the transformation to value-based payment is likely another three to five years away.

Pennsylvania Highlighted for Rural Health Care Innovation by Rmoore@haponline.org

The transformative changes hospitals and health systems face are front and center at this year’s American Hospital Association (AHA) Annual Meeting. During an executive session centered on rural issues, Pennsylvania’s hospitals were highlighted for their innovative work through the Rural Health Model.

U.S. HHS Leader Azar Pledges Historic Regulatory Reforms During 2019 by jkissinger@haponline.org

Federal Health and Human Services Secretary Alex Azar addressed health care attorneys this week about the role that regulatory reform plays in better health care at a lower cost.

News Release: Innovative Pilot Aims to Boost Rural Community Health by Rmoore@haponline.org

Members of the hospital community joined Wolf Administration leaders today to announce a new pilot program designed to improve rural community health and provide financial stability for rural hospitals.

PA Hospitals Encouraged to Submit Innovative Programs to 2019 HAP Achievement Awards by JCOLLINS@HAPONLINE.ORG

It’s no secret that Pennsylvania’s health care landscape is changing at an increasingly rapid pace and its hospitals and health systems are rising to that challenge through innovative programs to improve the quality of care, patient experience, and technology to meet the needs of the communities they serve. HAP members are encouraged to review the 2019 Achievement Awards Call for Entries and submit their innovative patient-centered initiatives that improve health care quality and efficiency and the health of their communities by March 1.

U.S. Departments of Health and Human Services, Treasury, Labor Release Health Care Competition Report by Rmoore@haponline.org

In fulfillment of an October, 2017, presidential Executive Order, the U.S. Departments of Health and Human Services, Treasury, and Labor today released a report intended to make recommendations that would facilitate a high-quality, affordable health care system by promoting choice and competition.

Forty Eight Percent of Survey Respondents Support National Health Insurance Program by JCOLLINS@HAPONLINE.ORG

According to the results of PwC’s Health Research Institute survey on national health plans, 48 percent of respondents support a national health insurance program available to all Americans in which physician practices and hospitals would remain private, while 57 percent support expanding Medicaid eligibility to any US resident.

AHA Calls for Changes to Stark Law to Ensure Greater Patient Care Coordination and Improved Outcomes by jkissinger@haponline.org

The American Hospital Association recently sent a letter to the Centers for Medicare & Medicaid Services calling for exceptions to the Stark Law to enable hospitals and physicians to coordinate care and improve patient outcomes.

Providers Weigh In on MACRA during U.S. House E&C Hearing by admin

Today, the U.S. House Energy and Commerce (E&C) Health Subcommittee held the fourth hearing on progress in the implementation of Medicare payment reforms under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

New Policy Brief Outlines Burdens of Restrictions on Advanced Practice Professionals by Rmoore@haponline.org

A recent policy brief published by The Hamilton Project, an economic policy initiative of the Brookings Institution, provides new insight into the ways that limitations in scope of practice are impacting health care in the United States.

Related Blogs

Patient and Family Engagement: Nice to Have—or Strategic Necessity? by jbisbee@haponline.org

For some time now, Medicare has been financially rewarding hospitals for good patient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS). Next year, about 2 percent of Pennsylvania hospitals’ Medicare fee-for-service payments will be affected by how well they do on the Centers for Medicare & Medicaid Services’ value-based purchasing calculations.

Congress and New President Must Approach ACA Repeal and Replace Carefully; Moving Too Quickly Could Be a Disaster by acarter@haponline.org
Health Care Quality Measures––Drinking from a Fire Hose of Data by acarter@haponline.org

Learn

There are no events for this issue.

See all Value-based Payment events
« Close