Physician Practice

Medicare unveils alternative payment models

Physician Practice Insider, February 10, 2015

Federal officials have announced an accelerated effort to use payment reform as a mechanism to shift Medicare and the broader healthcare industry away from the fee-for-service model. During a gathering in the nation's capital January 26, nearly two dozen healthcare industry stakeholders, including providers, commercial payers, and Department of Health and Human Services (HHS) Secretary Sylvia Burwell, announced plans to ramp up Medicare payment reforms featuring alternative payment models and value-based payments.

"Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in our common interest to build a healthcare system that delivers better care, spends healthcare dollars more wisely and results in healthier people," Burwell said. "We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement."

In a statement released January 26, HHS officials said the payment reform initiative includes creation of a "learning and action network" to promote the development and promulgation of value-based payment models. "HHS will intensify its work with states and private payers to support adoption of alternative payments models through their own aligned work, sometimes even exceeding the goals set for Medicare. The Network will hold its first meeting in March."

Senior HHS officials have highlighted a three-year payment reform timeline, which calls for boosting the percentage of fee-for-service Medicare reimbursements based on alternative payment models (APM) and increasing the percentage of all reimbursements linked to quality and value.

In the early phase of the payment reform initiative's implementation, APMs will be limited to:

  • Three pathways (Medicare's existing accountable care organization (ACO) efforts, the Pioneer ACO program and the Medicare Shared Savings Program)
  • Bundled payments
  • Payment models tied to patient-centered medical homes

Read more via HealthLeaders Media.

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