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Value-based Reimbursement Transition in the US

  • ID: 3507698
  • Report
  • December 2015
  • Region: United States
  • 54 Pages
  • Frost & Sullivan
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Market Due Diligence and Strategy Considerations
The US healthcare industry is undergoing a major transition toward value-based care, affecting all its stakeholders. Centers for Medicare and Medicaid Services (CMS) are steering this transition by developing policies and alternative payment models that affect all reimbursements for healthcare services. This document provides insight into CMS’s 2018 goals for this transition, the pathway adopted to achieve those goals, and current progress towards achieving these goals.

Financial performance of various industry stakeholders including physicians, providers, and the Accountable Care Organizations as well as anticipated short term trends for the CMS implemented programs are highlighted. The document includes case studies that throw light upon innovative business models designed by healthcare vendors that support providers undergoing this transition.

Key Questions Addressed:
- How are the HHS and CMS guiding the transition to value-based care?
- What kind of business models are being employed by healthcare vendors while adapting to this transition?
- What impact is the transition creating on physicians and providers?
- How are the various Alternative Payment Models performing?
- What are the future trends expected in the impact of this transition on all stakeholders?
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1. Executive Summary
  • Research Scope
  • Key Questions Addressed
  • CEO’s Perspective
2. Background
  • Tiers of Value-Derived Compensation
  • CMS-Announced Value-Based Care Goals
  • CMS Targeted Payment Transition
3. Pay-for-Performance Providers
  • Category 2-P4P for Providers
  • Re-admissions Reduction-Provider Impact
  • Value-Based Purchasing-Historical Provider Impact
  • Value-Based Purchasing-FY 2015 Provider Impact
4. Pay-for-Performance Physicians
  • Category 2-P4P for Physicians
  • Value-Based Modifier-Physician Impact
  • Value-Based Modifier-CY 2016, 2017 Physician Impact
  • EHR Meaningful Use-Physician Impact
5. Alternative Payment Models
  • Categories 3 & 4-Alternative Payment Models
  • Accountable Care Organizations Landscape
  • CMS Established ACOs
  • Categories 3 & 4-Other APMs
6. Other HHS Activities
  • Other Activities Impacting Healthcare Stakeholders
  • Impact on Healthcare Vendors
7. Risk Sharing Pricing Models in Health IT
  • Health Catalyst Risk-Sharing Contract in Pop Health
  • Health Catalyst Risk-Sharing Business Model Example
  • athenahealth
  • Sanitas
8. Population Health Management
  • Population Health Management, Central to VBR, is Difficult Business for Providers
  • Health Catalyst Led Operational Efficiency Program Yielded Benefits Worth $74 Million for Texas Children Hospital
  • Catholic Health Partners Transitioned to PCMH & Achieved ACO Success through Explorys’ PHM Platform
9. Conclusion
  • Summary
  • Conclusion
  • Legal Disclaimer
10. Appendix
  • Abbreviations
  • Hospital Value Based Purchasing Program- Parameter Weightage
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