Under the fee-for-service model that has governed care reimbursement in the U.S. for most of the country’s history, providers are paid per procedure or service provided. This means that the money is in volume, and many providers’ revenue streams are tuned to high-volume services: office visits, outpatient procedures, testing, etc. Recent trends in healthcare’s public and private sectors suggest this is changing (if not as quickly as many physicians, patients, and activists would like).
New tech, governmental intervention, and shifting patient and provider preferences are creating new opportunities for value-based care every day, Definitive Healthcare reports.
CMS has implemented eight valued-based programs since 2008, the most recent being its Alternative Payment Models program (built around high-quality, cost-effective care for specific conditions, populations, and care episodes). But in a 2021 Health Affairs report, CMS leadership suggested scaling back and simplifying its value-based models could improve provider participation and reduce confusion around “opposing, even conflicting incentives.” Read more.
