Health uncertainty goes beyond Senate debate
The ACA has helped move the healthcare system toward paying for value and away from traditional fee-for-service reimbursement. This type of payment has encouraged a volume-driven system where providers don't benefit from keeping people out of the hospital or avoiding unnecessary and expensive care. In a value-based system, providers assume some financial risk in the care of their patients and are reimbursed for the cost of care based on patient outcomes and other metrics.
The difference between these alternative payments and tried arrangements of managed care or capitation is strong quality indicators that are important for organizations to meet, said
"Patients have a guarantee that we're delivering value and not just cutting costs," Brown said.
Medicaid spending in
"One of the problems is that there is no real definition of value-based purchasing," said
Private insurance companies may set up contracts with no real analysis, he said, and managing high-quality data is fundamental to the efficacy of value-based medicine.
Bassett is primed to make changes toward a value-based system, Streck said, noting its development of a shared electronic medical record. An entirely employed clinician model also doesn't produce extra expenses when coordinating around patients.
"We have an advantage through home care, school-based health, and many partners who can help us affect the population in a positive way," said
Sixty percent of the network's patients are on Medicare, according to Anderson, and defining their needs along with those of other populations of patients is essential to bringing people better care and reducing costs.
A program to help primary care physicians better manage patients with chronic illnesses was started in 2015, partly in response to new Medicare penalties for providers who have high hospital readmission rates for certain illnesses. The state hopes to reduce avoidable hospital use by 25 percent over the next five years, according to the
Bassett saw cases where patients who used to be in the hospital every month were not readmitted for six months, Anderson said, and the sustainability of the program has been a link to subsequent work, including a new initiative for opiate addiction.
Managing the high-risk population is a key part of allocating resources right now, Anderson said. Patients are grateful to have regular contact with a care manager, a nurse who can answer questions about medication and treatment and connect with other health professionals to prevent gaps in care.
"A key piece of it is educating the patient to manage their own health," said Anderson.
Bassett and a majority of healthcare providers in the country still receive the bulk of their reimbursements through fee-for-service, but Brown says the network is on a journey to make the transition, although a timeline isn't clear.
Considering the current level of speculation around healthcare, it's a little difficult to know how it will go, and in some cases if at all, he said.
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