HHS plans accelerated shift to value-based reimbursement

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 - Sylvia M. Burwell

In an announcement from the Department of Health and Human Services (HHS), Secretary Sylvia Burwell, made a significant announcement regarding Medicare’s planned shift to value-based reimbursement in healthcare. A copy of the announcement is available here.

Burwell noted that “for the first time, [HHS is] setting clear goals—and establishing a clear timeline—for moving from volume to value in Medicare payments.” HHS set forth an aggressive timeline for this shift: by 2016, 30 percent of provider Medicare reimbursements will be outcomes-based, with an increase to 50 percent by 2018. Accountable Care Organizations (ACOs) and bundled payment models will play a central role in this shift.

In an effort to move away from models that reward volume, the agency anticipates restructuring reimbursement so that by 2016, 85 percent of payments are tied to quality and value, rising to 90 percent by 2018.

HHS acknowledged the key role the private sector needs to play in contributing to the success of these initiatives. “We want to continue and build upon our work with state Medicaid programs, private payers, employers, consumers, providers and other partners. We also recognize our partners in the private sector have the opportunity to be even more aggressive and we welcome that.” To “facilitate this public-private partnership,” The department is forming a Health Care Payment Learning & Action Network, which will meet for the first time next month.