INTRODUCTION TO SHIFTING PAYMENTS FROM VOLUME TO VALUE
Medicine is a noble profession, built on the altruistic motivations of caretakers. But it is hard to ignore the fact that perverse incentives that require clinicians to “do more” to get paid will predictably result in more medical care.
“Even among health professionals motivated to provide the best care possible, the structure of the payment incentives may not facilitate the actions needed to systematically improve the quality of care, and may even prevent such actions,” wrote the Institute of Medicine (now known as the National Academy of Medicine) in 2001.1
In this module we will discuss how different payment systems can help support a necessary shift from a health care system that is reimbursed for volume (seeing more patients and doing more tests) to a system that is reimbursed for value (making patients better). The goal is to align payment systems with the type of care we strive to deliver.
MODULE OUTCOMES
Characterize the ways in which low-value care is incentivized
Apply your knowledge of reimbursement mechanisms
Describe the current predominant fee-for-service payment model
Describe the drawbacks of the pay-for-performance reimbursement model
Recognize the pros and cons of bundled payment models
Recognize the pros and cons of capitation and global payment models
Explore the value of combining elements of different reimbursement models
Define value-based insurance design
Summarize the current evidence supporting the VBID strategy
Discuss the CMS application of the bundled payment model
Compare systems and policies for clinical care reimbursement that maximize value and reduce costs