Across the wide range of stakeholders in the health and human service field, most want to see an end to fee-for-service (FFS) reimbursement. What comes next is yet to be defined – but there are a range of pay-for-performance and/or risk-based reimbursement models that are loosely referred to as “value-based purchasing.”
The drivers of this shift to value-based purchasing are many – including the unwillingness of payers to increase service fees in the face of rising costs, the failure of Congress to address Medicare FFS rates, the changes (in many states) to child welfare system reimbursement, the pay-for-impact approach of social impact bonds, the increase in Medicare Advantage plans (now 27% of the population), and the move of state Medicaid plans to managed care (see 40 States Increased Prevalence of Medicaid Managed Care In 2012 Or Are Planning To In 2013 all members and 18 Of 26 States Moving To Capitated Payments For Integrated Dual Eligible Plans).
To get your team ready for this shift from pay-for-volume to pay-for-value, here are our team’s selections of the “must have” resources:
For deeper drive into value-based purchasing, don’t miss the presentation, How To Successfully Contract With Managed Care: A Comprehensive Guide For Provider Organizations, by Rhonda Robinson Beale, M.D., Chief Medical Officer, Optum Behavioral Health; Deb Adler, Senior Vice President of Network Services, Optum Behavioral Health; and me at The 2013 Planning & Innovation Institute. And look to OPEN MINDS to keep you current on these reimbursement trends as they happen.