1. Shifting Payments from Volume to Value

MODULE 9 | Section 1 of 12

Shifting Payments from Volume to Value

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
M9s1p2
Apply your knowledge of reimbursement mechanisms
M9s1p3
Describe the current predominant fee-for-service payment model
M9s1p4
Describe the drawbacks of the pay-for-performance reimbursement model
M9s1p5
Recognize the pros and cons of bundled payment models
M9s1p6
Recognize the pros and cons of capitation and global payment models
M9s1p7
Explore the value of combining elements of different reimbursement models
M9s1p8
Define value-based insurance design Summarize the current evidence supporting the VBID strategy
M9s1p9
Discuss the CMS application of the bundled payment model
M9s1p10
Compare systems and policies for clinical care reimbursement that maximize value and reduce costs
M9s1p11

REFERENCES

  1. 1- Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Report. Washington, DC: National Academy Press, 2001:194.

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