Value-based care is a form of reimbursement that ties payments to quality performance, patient outcomes, and appropriate reductions in spending instead of the volume of services provided. The goal is to keep patients healthier for longer while curbing the nation’s unsustainable spending on low-value healthcare services.
In value-based care arrangements, healthcare providers contract with government or commercial payers to meet certain clinical and financial benchmarks, which are designed to promote proactive, preventive, coordinated care.
Satisfactory performance on these measures leads to bonuses, a share of any savings produced by keeping spending below benchmark levels, or higher reimbursement rates. Poor performance may result in reimbursement decreases or the need to repay a portion of any shared financial losses.
The Medicare Shared Savings Program (MSSP) was launched in 2012 to encourage providers to participate in value-based care. The MSSP allows hospitals, community health centers, physicians and other types of clinical professionals to band together into accountable care organizations (ACOs), or groups of providers who are collectively required to meet clinical and financial performance goals for defined and attributed populations.
More than 10.5 million assigned Medicare beneficiaries received care from an ACO in 2018. Millions more American patients receive care from providers participating in similar arrangements with Medicaid or commercial payers.
In 2018, the Centers for Medicare and Medicaid Services (CMS) made major changes to the MSSP and renamed the program Pathways to Success. With multiple tracks based on an ACO’s experience and revenue volume, Pathways to Success aims to ensure that more and more healthcare providers can successfully transition to the value-based care environment.
However, all participants are now required to embrace progressively higher levels of financial risk as they move through the program’s timeline. This is intended to promote continuous improvement and innovation across the healthcare system.
Primary care providers are at the heart of the healthcare experience. They’re also at the heart of everything we do here at Aledade.
If you’re debating the choice between joining a hospital-based ACO and taking the lead yourself, consider this: physician-led ACOs produce significantly more savings than hospital-led ACOs participating in the MSSP, according to a recent analysis published in the New England Journal of Medicine.
This is because the incentives in physician-led ACOs are fully aligned with the key components of value-based care: prioritizing prevention, reducing unnecessary hospital utilization, and managing chronic conditions proactively.
In 2018, Aledade’s physician-led ACOs reduced hospitalizations by an average of 6 percent, reduced ED visits by an average of 6 percent, and reduced the number of skilled nursing facility stays by an average of 17 percent.
Read more about how Aledade’s solutions can help you succeed in a physician-led ACO while maintaining your autonomy and independence.Learn More
If you are interested in learning more about how Aledade can help your practice in the new healthcare economy, schedule a call with us and we will provide you a free customized opportunity analysis to help you understand the benefits of joining an Aledade ACO.