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An Introduction to Value-Based Payment Models

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Pearl | November 30, 2016 | Payers, Healthcare Reform, Pearls, Population Health, Practice Models
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Originally published at: www.physicianspractice.com

For many physicians and practices, their introduction to “value based” contracts will come in the form of understanding Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). However, if you are getting paid on a “pay for performance” basis from the commercial payers, you are already participating in value-based contracts.

The “value-based purchasing” model evolved from work done by the University of Michigan Center for Value-Based Insurance Design, a non-profit that was established in 2005 to develop, evaluate, and promote value-based insurance initiatives. Their initial research studied the impact of healthcare costs and paying for care “events,” rather than outcomes. Eventually value-based reform helped to shape the Patient Protection and Affordable Care Act (the ACA) signed into law in 2010.

So what does all that mean to you? The bottom line is that “payers” — insurance companies, employers, and now consumers themselves — are looking for more value for the money they spend on healthcare.

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The Potential of Patient-Centered Specialty Practice

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Pearl | September 02, 2015 | Practice Models, Healthcare Reform, Patients, Pearls, Physician Productivity
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What is PCSP?

Patient-Centered Specialty Practice (PCSP) is a recognition program from the National Committee for Quality Assurance (NCQA) that went into effect in 2013. The PCSP program was designed in many ways to complement the success of NCQA’s Patient-Centered Medical Home (PCMH) program and expand its reach. The goal of the program is to encourage excellent care coordination by specialty practices in the outpatient setting, leading to less duplication of procedures and fewer hospitalizations.

Much like the PCMH program, the PCSP program focuses on proactive coordination of care, information sharing among clinicians involved in a patient’s care, and a centering of care around the patient (versus around the care setting).

According to the NCQA, “Specialists who achieve NCQA PCSP Recognition will show purchasers (consumers, health plans, employers and government agencies) that they have undergone a rigorous and independent review to assess their capabilities and commitment to excellence in sharing and using information to coordinate care.” What this means practically is that practices that undergo the process will be better placed to meet the challenges of the marketplace.

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