Episodic Payment- A Window into Value-Based Transformation

Episodic Payment- A Window into Value-Based Transformation

On October 17, Brian Ellsworth, Director, Payment Transformation, and Erin Shvetzoff Hennessey, Executive Vice President, Consulting, presented at the American Health Care Association meeting in Las Vegas. The meeting was an important time of education for thousands of health care providers from all across the country. Brian and Erin presented on value-based payment transformation. The presentation included a discussion of the ever-evolving Medicare marketplace, alternative payment models, and predictions about what is coming next. Given ongoing Federal budget deficits, statutorily required programs like the IMPACT act and new physician payment rules, value-based payment is here to stay.  CMS’ tone has changed, but there still is a strong commitment to lowering costs and improving quality, especially by allowing providers to innovate.

Hospitals are sensitized more than ever to post-acute care performance due to readmission and Medicare Spending per Beneficiary (MSPB) metrics. Skilled Nursing Facility (SNF) incentives will then align to these metrics in late 2018, with risk-adjusted readmission Medicare Part A rate changes. Following in the Medicare footsteps are Medicare Advantage plans- with over 40% penetration in some states – and other payors. Given these aligned risks and incentives, partnership between acute and post-acute care is growing and evolving.

The session concluded with the bottom line of value-based payment and alternative payment models:

  1. Value-based payment will continue to expand
  2. MACRA will drive Advanced Alternative Payment Models (APMs)
  3. Other payors are climbing on board
  4. Post-acute care will continue to be under the microscope

The session concluded with a discussion of the anticipated next round of Bundled Payments for Care Improvement program, highlighting the keys for success.

Will you be ready? Health Dimensions Group can help your organization prepare. For more information, please visit www.healthdimensionsgroup.com/services, or contact us at 763.537.5700 or info@hdgi1.com.

Authored by: Brian Ellsworth, Director, Payment Transformation

 

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