Value Based Payments
The world of value-based care is at physicians' doorstep. What is value-based care? Simply, value-based care means achieving the best outcomes at the lowest cost. Most people want affordable, high-quality health care. The healthcare organizations that can do that will be rewarded. That's where analyzing processes, measuring outcomes, and changing practices come into play: Most doctors think they already deliver high-quality, affordable care. But if you don't measure it, you don't know it.
Achieving value also requires restructuring how health care is paid for and redesigning the way care is delivered and having payment that supports the design. That's value-based care: when the care delivery and the payment go hand in hand.
Some large private practices and organizations are attempting to better link the two with models like accountable care organizations (ACOs) and bundled payments; Medicare is trying through several programs that encourage physicians to track their quality activities and adopt technology to promote improvements. Driven by the Affordable Care Act, most of these programs steer away from payments based purely on the number of patients physicians see or tests and procedures they perform, and they add incentives and penalties based on cost and quality factors, such as better outcomes and patient adherence to recommended care.
Here are some tools and resources to help you step confidently out into this evolving arena.
Medicare Payment Reform Practice Help
- The Quality Improvement Resource Center connects you with TMA-approved vendors to guide you through the Physician Quality Reporting System (PQRS) and provides clinical quality improvement tools to engage your patients.
- The Technology Resource Center has everything you need to know about meaningful use reporting and electronic health record implementation.
TMF Health Quality Institute
Medicare Quality and Resource Use Reports (QRURs)
Download and check these performance feedback reports to preview the quality and cost scores Medicare uses to calculate your payments under the new value-based payment modifier. The quality measures and scores come from data you report to PQRS; Medicare supplies data for the services and procedures contributing most to your patients' costs.
For no-cost consulting on Medicare's quality reporting programs, turn to the TMF Quality Innovation Network Quality Improvement Organization, an offshoot of the TMF Health Quality Institute. Under contract with Medicare, TMF has created several educational networks you can join:
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Information on this page was provided by the organizations listed, is for educational uses only, and is subject to change. The listings may not be comprehensive. To add an ACO to this page, please contact DCMS. DCMS does not endorse any organizations listed on this page, and information provided does not necessarily reflect the views of DCMS.