About a year ago, the Department of Health and Human Services (HHS) announced its first set of goals for shifting Medicare reimbursements from volume to value, starting with moving 30 percent of payments to alternative payment models by the end of 2016.
Earlier this month, HHS announced that it had reached its 30 percent goal nearly 10 months ahead of schedule, with payments to alternative payment models up from an estimated 20 percent in 2015.
Alternative payment models include ACOs, bundled payment initiatives, primary care transformation models such as medical homes, and dual eligible (Medicare/Medicaid) programs. Most of these programs are still in the demonstration or testing phase and are being run out of the Center for Medicare and Medicaid Innovation (CMMI), an offshoot of the Centers for Medicare & Medicaid Services (CMS).
In its March 3 press release, HHS noted the accomplishment and attributed its success to the Affordable Care Act and the efforts of multiple stakeholders:
“Before the Affordable Care Act, Medicare paid essentially $0 through alternative payment models. By 2014, approximately 20 percent of payments were made through alternative payment models, and today more than 30 percent of payments are made through alternative payment models. CMS is joined by dozens of insurance companies, health systems, employers, and organizations who have set their own goals to move to alternative payment models.”
CMS’ next goal is to make 50 percent of payments through alternative payment models by the end of 2018.
Impact for NextGen Healthcare clients: This news demonstrates how quickly the federal government is moving the Medicare program away from fee-for-service and into alternative payment models. This transition is likely to accelerate even more in the next several years as the financial incentives under the MACRA law take effect and private payers increasingly follow CMS’ lead. NextGen Healthcare supports a large number of clients already participating in these programs, as we implement enhancements and solutions that give our clients the tools they need to succeed in a fast-changing healthcare economy.