11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters

CMS's ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments often a single innovation at a time testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare's per capita cost. 11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours' building of a business case for its multidisciplinary care team to the John C. Lincoln ACO's deep dive into data analytics to identify and manage the care of high-risk, high-cost 'VIP' patients to 'beat the benchmark' to WellPoint's engagement of specialists in care coordination. There is also a look at the value proposition inherent in Medicare's recently announced Chronic Care Management codes. There are many lessons to learn from the 11 models outlined in this 30-page quick reference, which summarizes hours of thought leadership on the shifting healthcare payment landscape. These synopses are highlighted with key charts as well as Q&A clarifying the value-based initiatives. The report concludes with a look at drivers behind healthcare's transition to value as well as some new players and 'disruptive innovators' to monitor during the industry's new era. *Table of Contents: *How Bon Secours Gets Paid for Providing Value-Based Healthcare *Building a Business Case for Multidisciplinary Team *Humana Physician Quality Rewards Boost Population Health Across Accountable Care Continuum *Star Rewards to Medical Home *Healthcare Strategy Group: Factors Driving Resurgence in the Physician-Hospital Organization Model Today *WellPoint Care Coordination Compacts: Establishing Accountability, Clarity between Physicians and Specialists *Patient-Centered Specialty Care *BCBS Michigan PGIP Value Partnership Translates to Quality Improvement, Cost Savings *OSC: Medical Home 'on Steroids' *Optum's 3 Essentials for Shift to Value-Based Physician Compensation *Guidelines for a Successful Physician Compensation Strategy *WellPoint 'Leaves No Primary Care Practice Behind' on Road to Value-Based Payment Reform *3 Types of Physician Practice Support *Monarch Pioneer ACO to Specialists: If the Care Coordination Role Fits, Wear It *Top Scorer in Pioneer's Patient-Centered Metrics *John C. Lincoln's Deeper Data Dive Improves ACO Performance, Quality *Military Medics for Transition Coaches *ACO Patient Navigators Analyze Quality Reports *Atrius Health High-Risk Patient Roster Helps Pioneer ACO 'Beat the Benchmark' *6 Clinical and Technical Initiatives *Medicare Chronic Care Management Code: Test-Driving a Value-Based Healthcare Delivery Model *7 Gray Areas in CMS CCM Requirements *3 Factors Driving Healthcare's Transition from Volume to Value *Transparency, New Players Narrow Payor-Provider Divide *Healthcare Companies with 'Disruptive Strategies'