Value-based Reimbursement Transition in the US

Market Due Diligence and Strategy Considerations

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The US healthcare industry is undergoing a major transition toward value-based care, affecting all its stakeholders. Centers for Medicare and Medicaid Services (CMS) are steering this transition by developing policies and alternative payment models that affect all reimbursements for healthcare services. This document provides insight into CMS’s 2018 goals for this transition, the pathway adopted to achieve those goals, and current progress towards achieving these goals. Financial performance of various industry stakeholders including physicians, providers, and the Accountable Care Organizations as well as anticipated short term trends for the CMS implemented programs are highlighted. The document includes cas

Table of Contents

Value-based Reimbursement Transition in the USExecutive SummaryResearch ScopeKey Questions AddressedCEO’s PerspectiveBackgroundBackgroundTiers of Value-Derived CompensationCMS-Announced Value-Based Care GoalsCMS Targeted Payment TransitionPay-for-Performance ProvidersCategory 2—P4P for ProvidersRe-admissions Reduction—Provider ImpactValue-Based Purchasing—Historical Provider ImpactValue-Based Purchasing—FY 2015 Provider ImpactPay-for-Performance PhysiciansCategory 2—P4P for PhysiciansValue-Based Modifier—Physician ImpactValue-Based Modifier—CY 2016, 2017 Physician ImpactEHR Meaningful Use—Physician ImpactAlternative Payment ModelsCategories 3 & 4—Alternative Payment ModelsAccountable Care Organizations LandscapeCMS Established ACOsCMS Established ACOs (continued)Categories 3 & 4—Other APMsOther HHS ActivitiesOther Activities Impacting Healthcare StakeholdersImpact on Healthcare Vendors Risk Sharing Pricing Models in Health ITHealth Catalyst Risk-Sharing Contract in Pop HealthHealth Catalyst Risk-Sharing Business Model ExampleathenahealthSanitasPopulation Health ManagementPopulation Health Management, Central to VBR, is Difficult Business for ProvidersHealth Catalyst Led Operational Efficiency Program Yielded Benefits Worth $74 Million for Texas Children HospitalCatholic Health Partners Transitioned to PCMH & Achieved ACO Success through Explorys’ PHM PlatformConclusionSummaryConclusionLegal DisclaimerAppendixAbbreviationsHospital Value Based Purchasing Program— Parameter WeightageThe Frost & Sullivan StoryThe Frost & Sullivan StoryValue Proposition—Future of Your Company & CareerGlobal PerspectiveIndustry Convergence360º Research PerspectiveImplementation ExcellenceOur Blue Ocean Strategy

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