Value-Based Reimbursement: The Future of Healthcare

June 28, 2022

Over the past several years, healthcare has begun moving toward the adoption of value-based reimbursement (VBR). The transition is picking up speed as the industry begins to emerge from the COVID pandemic.  

By 2030, CMS expects that 100% of patients with original Medicare will be in value-based care relationships with accountability for quality and total cost of care as clinicians who are currently a part of the Quality Payment Program (both PCP and Specialty) continue to drive toward high quality, value-based care.  

By 2030, CMS expects that 100% of patients with original Medicare will be in value-based care relationships.

The healthcare industry is one of the most competitive and fluid industries in the world and things like insurance costs, M&As, increased regulatory requirements and the demand for an enhanced patient-focused healthcare experience add to the complexity.  

To navigate the challenges, providers must better manage processes, leverage data for insights and compliance, improve operational proficiencies and more. One key process of critical importance is contract management, which directly impacts physician practice revenue and functionality. According to Black Book Market Research, 96% of providers do not have an appropriate contract management system in place.  

96% of providers do not have an appropriate contract management system in place .- Black Book Market Research  

Every practice enters into multiple contracts across the payer landscape and almost 10% of these contracts get lost. This, in turn, creates an urgent need for an efficient management strategy since only then can a practice provide patients with the best care, bring down operating costs, maintain compliance with regulatory laws, mitigate risks and more.

Adopting the VBR model is fast becoming a top priority for CFOs, and that is only possible with a comprehensive contract management strategy.  

Evaluating the benefits of value-based contracts 

Evaluating a specific value-based contract requires weighing the potential benefits and risks related to the practice’s capabilities and resources, as well as the financial impact. Although there will be growing pains, moving to a value-based care system can ensure financial sustainability.

Recent research has shown that value-based reimbursement models are successful in the long run. Providers can choose from several models depending on the level of risk they are willing to take. As with all endeavors, the higher the risk, the higher the reward potential.  

Is your practice prepared to transition from fee-for-service to value-based care?

A practice assessment may be one of the most critical steps to preparing for a transition to VBR. Understanding patient demographics, claims and clinical data is essential as contracting becomes more sophisticated.  

Having a qualified third-party assess all or part of your medical practice can uncover missed revenue opportunities and provide strategic direction as you navigate the many reimbursement, regulatory and market pressures that plague providers.

Value-based contracting is a complex process. Each contract varies; therefore, practitioners must rely on every available insight to truly understand where bonuses, cost savings and patient outcomes for each population are possible within their practice.  

Legacy payers and many major providers have already embraced collaborative strategies for meeting quality and spending.  

As one CEO put it, Value-based care is different than what you’re used to, but it can be a meaningful and sustainable alternative for fee-for-service.”

Contact R1 about conducting a practice assessment for value-based care. 

Author Bio: Brian Bellamy is a Vice President of Payer Contracting.

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