Jul 27, 2016

5 Ways Value-Based Payment Model Impacts the Healthcare Industry

Alanna Diffendal   |   Updated June 8   |  Reading time: 2 minutes

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The impacts of value-based reimbursement are plentiful in the healthcare industry as a result of government regulations. The Centers for Medicare & Medicaid Services (CMS) requires 50% of payments to be value-based by 2018. The transition from the traditional fee for service model, where physicians are compensated based on the number of treatments, to the value-based model is not an easy shift for some physicians.

In a survey conducted by Xerox, 43% of healthcare providers and payers state that value-based contracts account for less than 10% of their current portfolio. This leaves many to question the future of reimbursement.

In addition to reimbursement rates, what other outcomes can be predicted as a result of value-based payments? Managed Healthcare Executive discusses 5 distinct ways value based pricing impacts various aspects of the healthcare industry.

1. Optimization of resources

Providers will have to shift the allocation of resources in order to improve individual quality of care. They may see an increase in savings if they are able to instill healthier consumer behaviors and patient health outcomes.

2. A focus on health outcomes

While physicians undoubtedly aspire to provide the highest quality of patient care, the traditional method of fee for service payment forces physicians to find a complex balance— meeting the individual needs of every patient and evaluating a certain number of patients daily. The value based payment model, if executed correctly, allows physicians to be compensated for spending more time evaluating and treating individual patients without the concern of seeing a higher volume of patients.

3. Appropriate utilization of care

Many would argue how the United States has some of the top medical institutions and physicians in the world; thousands of people fly to the US to receive the treatment they so desperately seek. While the US in clearly a leader in medical treatment, there is still work to be done with regard to preventative care.

Xerox research shows that 50% of millennials, 45% of Gen Xers, and 39% of baby boomers delay treatment due to high costs. When conditions are not evaluated at an early stage, this can lead to rising payments for the patient. Under a value-based model, people are more likely to appropriately utilize care and to incorporate behaviors with sustainable, healthier outcomes.

4. Realignment of BPO service

Business Process Outsourcing (BPO) vendors typically provide transactional services or single solutions. Now, they will be forced to develop new product to align more with value-based pricing.

RXNT offers these innovative solutions as an affordable price, and also can lead your practice in the right direction to meet MACRA requirements.

5. Population health management

Population health management will continues to expand with increased consumerization and innovative technologies.

The value based payment model, while more robust and complex than the traditional method of payment, aims to provide greater patient care while meeting certain quality measures. RXNT|PM and RXNT|EHR can help physicians and practices ensure they not only taking the right direction, but also streamline their workflow. To learn more about the benefits of RXNT’s fully integrated solutions for your practices or to schedule a free demonstration, contact us at 800-943-7968 option 3 or email us at [email protected].

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