MACRA Medicare

What is value-based care and how is it different?

What is “Value-Based Care?” Historically, Medicare has been a fee-for-service reimbursement model that promoted the quantity of service, and healthcare providers are reimbursed for services performed. More services and billing codes, plus more reimbursements or payments. This environment created incentives for providers to order more tests and procedures, and of course manage more patients. This hasn’t resulted in better outcomes for patients and has been driving up the cots of healthcare.  

Value-based care, or also known as pay for performance (P4P) healthcare, MACRA, Is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Some examples of performance measures are the reduction of patient hospitalizations, increased preventive services, and management of certain patients’ chronic medical conditions.

In a nutshell, value-based care focuses on patient outcomes and the quality of care being delivered; not quantity. This means that if a physician is effective in treating their patients’ medical conditions, performing preventive screenings, managing chronic conditions, and reducing hospital admissions, they’ll be compensated more for that quality of care. 

When did Medicare begin paying doctors and medical groups for quality rather than quantity?

While limited groups and circumstances have existed for some time, this payment model widely began implementation in 2019. This is a result of the bipartisan legislation MACRA, which passed in 2015.

Here’s what the Centers for Medicare and Medicaid Services (CMS) has to say about the new payment model-

Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare. These programs are part of our larger quality strategy to reform how health care is delivered and paid for. Value-based programs also support our three-part aim:

  • Better care for individuals
  • Better health for populations
  • Lower cost

At Medicare Advocates, we want to ensure that you have a health plan that promotes you and your healthcare outcomes. Talk to us today and we’ll make sure you are getting the most out of Medicare. Click here, to schedule time with an Advocate.

To learn more, please read this article.

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