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The Centers for Medicare and Medicaid Services (CMS) is displaying a strong commitment to transitioning the healthcare system towards 100% value-based care (VBC) by 2030. This ambitious goal signifies a significant shift from the traditional fee-for-service model to value-based payment models. The move towards VBC is driven by the increasing recognition of the potential benefits it offers to all stakeholders – patients, healthcare providers, and payers.
Although VBC is intended to improve the healthcare system’s efficiency, quality, and patient outcomes, it encompasses various payment structures and approaches with multiple dynamics for payers and providers. As providers gradually transition into VBC, one of the starting points in the transition is often the Pay-for-Performance (P4P) model. Under P4P, providers receive financial incentives based on their ability to achieve specific quality metrics and outcomes for their patients. The P4P model is designed to encourage healthcare providers to focus on delivering high-quality care and achieving positive health outcomes for their patients. By tying financial incentives to performance on these quality metrics, providers are motivated to enhance their care processes and adopt evidence-based practices to meet the desired targets.
Discussion Topics within this presentation series include:
1. 9/27 – Intro to Value-based Care
Speaker: Erica Archuleta, Payer Solutions Director
This session provides a foundational understanding of what value-based care is all about. It includes defining VBC and explaining the rationale behind moving away from fee-for-service towards value-based models. It also introduces the audience to the different types of VBC, such as Pay-for-Performance (P4P), bundled payments, accountable care organizations (ACOs), capitation and full-risk contracts.
2. 10/24 – VBC Across Payers
Speakers: Janine Savage and Erica Archuleta
This session focuses on how value-based care is being adopted across various payer organizations, including Medicare, Medicaid, and private insurance companies. It explores the strategies each payer uses to promote the adoption of VBC among healthcare providers. Some of these strategies may involve offering financial incentives to providers based on their ability to achieve quality metrics and outcomes. Additionally, the session covers alternative payment models and initiatives that encourage care coordination among different providers.
3. 11/15 – VBC Across Settings
Speaker: Erica Archuleta
This session highlights how value-based care is being implemented in different healthcare settings, particularly in hospitals, nursing facilities, and primary care. It acknowledges that the transition to VBC can present unique challenges and opportunities for each setting. For example, providers may need to adapt their workflows and care delivery processes to align with value-based strategies effectively.
4. 1/18 – Real-life Operationalization of VBC
Speakers: Janine Savage and Erica Archuleta
This session delves into concrete examples of how value-based care is being put into practice in real-world scenarios. It will showcase successful VBC initiatives in hospitals and nursing facilities, providing insights into the key factors contributing to their success. The role of data analytics is emphasized in supporting the implementation of VBC, as it enables providers to analyze patient data and make informed decisions, leading to better patient management and outcomes.