Most of us see our doctors in a fee-for-service system \u2013 this is where doctors and hospitals charge fees for each separate service they provide. Office visits, tests, procedures, and even microtasks like individual screenings can be billed separately. One major drawback to fee-for-service is rewarding quantity over quality. This type of payment model can lead to ordering tests or procedures that may be unnecessary and in turn drive up health care costs rather than rewarding tests and procedures that are more likely to make you healthy or rewarding outcomes. In this model, we end up paying for the quantity or volume of health care services that we receive.<\/p>\n
This is the most traditional and most widely used payment model in our country\u2019s health care system. However, now that many groups are calling to replace volume or quantity with care based around value or quality, fee-for-service\u2019s reign as the top model may be fleeting. The whole country is moving toward value-based care. \u00a0In 2010, the Federal Affordable Care Act (ACA) introduced a number of new alternative payment models. As with any long-standing tradition, especially in a system as large and complex as health care, such a significant change can be like persuading hikers to try a new trail up a mountain rather than sticking to the same familiar, well-worn path; even if the new trail has better views. This can take some coaxing.<\/p>\n In the years following the passage of the ACA, much of that coaxing has come from Federal and State governments. In January 2014, the State Health Care Cost Containment Commission, a bipartisan group co-chaired by State Governors, came out with a report<\/a> concluding that the most significant way to drive down health care\u00a0costs is by eliminating fee-for-service payment. This was big! That the report came from a coalition of states was key \u2013 as states deliver insurance to roughly 80 million individuals. Washington State has a goal that 80% of state-financed health care and 50% of the private market are part of value-based payment by 2019. We are also seeing employers who purchase health care for their employees lead the way to value-based care. Read more about that in the Harvard Business Review here<\/a><\/span>.<\/p>\n Additionally, the final rule on 2015\u2019s Medicare Access and CHIP Reauthorization Act (MACRA)<\/a><\/span> came out within the last two weeks, replacing the old sustainable growth-rate formula that determined physician pay for Medicare with a new pathway to value-based payment. The two pathways, alternative payment models or the Merit-Based Incentive Payment System (MIPS), are described in a reader-friendly interactive format here<\/a><\/span>.<\/p>\n What to Expect Next<\/strong> Emily Wittenhagen Ginny Weir, MPH
\n
\nQuality vs. Quantity = Value vs. Volume
\n<\/strong>Alternatives to fee-for-service are often called alternative or accountable payment models or value-based purchasing<\/a><\/span>. These alternative models include bundled payments<\/a><\/span>\u00a0like those we have been developing at the Bree Collaborative and programs like the Health Care Authority\u2019s Accountable Care Programs<\/a><\/span>. These models reward high-quality care that prevents problems before they occur, that uses evidence-based procedures shown to be effective, and that is coordinated around the patient\u2019s needs.<\/p>\n
\nAs the tide continues to shift, we should see a steady number of systems moving toward value-based payment models. In many locations the transition will likely involve various forms of hybrid payment systems. As Utah Governor Michael Leavitt, one of the chairs of the State Health Care Cost Containment Commission, told Paul Demko for Modern Healthcare<\/a><\/span> in 2014, \u201cThis is a five- to 10-year horizon we\u2019re talking about, not something that is going to happen quickly<\/em>.\u201d Stay tuned for more information as this movement unfolds and how these changes will affect health care here in Washington State.<\/p>\n
\nBree Collaborative Program Assistant<\/span><\/p>\n
\n<\/span>Bree Collaborative Program Director<\/p>\n","protected":false},"excerpt":{"rendered":"Most of us see our doctors in a fee-for-service system \u2013 this is where doctors and hospitals charge fees for each separate service they provide. Office visits, tests, procedures, and…","protected":false},"author":88,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[1],"tags":[19,30,33,34,35,36,37,41,52,53,54,61,62],"class_list":["post-2825","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-bree-collaborative","tag-employee-health","tag-guidelines","tag-harms","tag-health-care","tag-health-care-improvement","tag-healthcare","tag-knee-replacement","tag-patient-engagement","tag-patient-health","tag-patient-safety","tag-shared-decision-making","tag-side-effects"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/posts\/2825","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/users\/88"}],"replies":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/comments?post=2825"}],"version-history":[{"count":0,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/posts\/2825\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/media?parent=2825"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/categories?post=2825"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/tags?post=2825"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}