Changing the Way We Pay for—and Deliver—Care in the United States

Posted by The Evidence Blog on February 3, 2015

The Centers for Medicare & Medicaid Services (CMS) recently announced ambitious plans in its effort to change the way it pays providers for the care delivered to patients. Before passage of the Affordable Care Act, Medicare reimbursed most providers based on volume, for example, how many patients they treated and how many tests or procedures they performed, regardless of whether those services improved the health and well-being of the patient. That fee-for-service model started changing when the CMS began linking Medicare fee-for-service payments to quality or value. In fact, in 2014, an estimated 20% of Medicare reimbursements were linked to quality or value.

CMS has established clear targets in its attempt to reward value and promote coordination of care. The agency’s goal is to link 85% of all Medicare fee-for-services payments to quality or value by 2016 and 90% by 2018. In an article published in the January 26th issue of the New England Journal of Medicine, Sylvia Burwell, U.S. Secretary of Health and Human Services, described 3 strategies CMS will use to improve the value of the care provided to patients:

  • Incentives that will encourage providers to deliver high-quality care, such as alternative payment models.
  • Policies to encourage greater care coordination among providers and within practice sites and greater attention to population health.
  • Improved availability of resources to guide decision making.

At Hayes, we believe that another strategy to incorporate is the adoption and implementation of evidence-based approaches to care. Doing so will help to manage diffusion of health technologies, reduce disparities and variations in coverage and care, promote use of effective and high-value services, and ensure smarter spending of our healthcare dollars.

Topics: Hayes Blog

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