Value-based Reimbursement Transition in the US

Value-based Reimbursement Transition in the US

Market Due Diligence and Strategy Considerations

RELEASE DATE
11-Dec-2015
REGION
Global
Deliverable Type
Market Research
Research Code: 9AB9-00-44-00-00
SKU: HC02566-GL-MR_16688
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Description

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 case studies that throw light upon innovative business models designed by healthcare vendors that support providers undergoing this transition.

Table of Contents

Research Scope

Key Questions Addressed

CEO’s Perspective

Background

Tiers of Value-Derived Compensation

CMS-Announced Value-Based Care Goals

CMS Targeted Payment Transition

Category 2—P4P for Providers

Re-admissions Reduction—Provider Impact

Value-Based Purchasing—Historical Provider Impact

Value-Based Purchasing—FY 2015 Provider Impact

Category 2—P4P for Physicians

Value-Based Modifier—Physician Impact

Value-Based Modifier—CY 2016, 2017 Physician Impact

EHR Meaningful Use—Physician Impact

Categories 3 & 4—Alternative Payment Models

Accountable Care Organizations Landscape

CMS Established ACOs

CMS Established ACOs (continued)

Categories 3 & 4—Other APMs

Other Activities Impacting Healthcare Stakeholders

Impact on Healthcare Vendors

Health Catalyst Risk-Sharing Contract in Pop Health

Health Catalyst Risk-Sharing Business Model Example

athenahealth

Sanitas

Population Health Management, Central to VBR, is Difficult Business for Providers

Health Catalyst Led Operational Efficiency Program Yielded Benefits Worth $74 Million for Texas Children Hospital

Catholic Health Partners Transitioned to PCMH & Achieved ACO Success through Explorys’ PHM Platform

Summary

Conclusion

Legal Disclaimer

Abbreviations

Hospital Value Based Purchasing Program— Parameter Weightage

The Frost & Sullivan Story

Value Proposition—Future of Your Company & Career

Global Perspective

Industry Convergence

360º Research Perspective

Implementation Excellence

Our Blue Ocean Strategy

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 case studies that throw light upon innovative business models designed by healthcare vendors that support providers undergoing this transition.
More Information
Deliverable Type Market Research
No Index No
Podcast No
Author Siddharth Shah
Industries Healthcare
WIP Number 9AB9-00-44-00-00
Keyword 1 Value-based Reimbursement Transition in the US
Keyword 2 Value-based Reimbursement Transition
Keyword 3 value-based programs
Is Prebook No