Centers for Medicare and Medicaid Services (CMS) is shifting from fee-for-service to outcomes-based reimbursement. What will that mean for providers, employers and patients?
The ever-changing health care landscape is preparing for another shift with the approach of 2018, says Libby Hornibrook, principal and leader of the healthcare practice group for Minneapolis-based DS+B | CPAs + Business Advisors. The new year will introduce the Centers for Medicare and Medicaid Services’ (CMS) move from a volume-based to value-based payment program.
“With value-based care, providers are reimbursed based on quality outcomes and efficiency of care, rather than the current, fee-for-service model of volume-based care,” says Hornibrook.
DS+B’s healthcare team provides guidance to physicians and provider groups to help them prepare for this new shift in regulation on patient care.
“We provide the same assistance to our current non-physician clients and general public as a whole. We bring a proactive approach and work personally with them in understanding the outcomes that our clients may experience due to this change,” says Hornibrook.
Value-based care is proactive, rather than reactive, explains Hornibrook, and emphasizes preventive care and evidence-based medicine. It is also more cost-effective, eliminating treatments that are not deemed to have a measurable positive impact on the health of the patient.
“CMS is the driver for value-based care and more than likely other insurance companies will follow suit,” says Hornibrook. “With this transition, providers, employers, and particularly consumers will all need to change the way they approach and view health care.”
For health care providers, a volume-based payment plan will move them further away from siloed care, encouraging increased communication among primary care, specialists and patients. Emphasis will be on metrics, so providers will need to effectively track and analyze data across a care network. And they will also need to work in concert with their patients.
“It’s a culture shift for providers,” says Hornibrook. “They will not only have to adjust how they do business, but how they provide care. It’s looking at a patient’s current health situation and executing on a plan that ensures the desired health outcome. In the end game, value-based care is better for both patients and providers. In the short-term, however, providers will need to develop and incorporate new approaches to serving patients. This is where our team is focused: supporting healthcare management teams with innovative approaches so they can remain profitable and independent.”
Employers can set the tone for value-based care by encouraging their employees to take greater control of their health—whether that be by choosing the best insurance plan to meet their needs and fit their budget or by participating in workplace wellness programs, such as free flu shots, smoking cessation programs or fitness challenges. “From an employer standpoint, the emphasis is on education, particularly when employees are going through open enrollment,” says Hornibrook.
By encouraging employees to be more involved in their health outcomes, employers may not only have fewer claims and a healthier workforce, but they could also experience an increase in productivity thanks to a reduction in sick days.
“From a patient standpoint, value-based care means that the patient has to be more involved with their health plan and their providers. They have to have more conversations with their providers and truly get to understand what’s going on with their own care,” says Hornibrook. “As they become more involved it will lead to better outcomes for them.”
One way to be more engaged, says Hornibrook, is learning how to communicate with their providers. “When you’re sitting down with your provider, repeat back to them what you just heard, so they know that you understand. Ultimately value-based care should increase the trust between the provider and the patient.”
But in the meantime, Hornibrook says, patients should practice patience with this new way of providing care. “At the front end of value-based care, there may be some additional costs for the patient. But in the long run, it will be for the greater good.”
Headquarters: Minneapolis, MN
Leadership: Libby Hornibrook – Principal|Healthcare Practice Group Leader; Sean Boland – Managing Principal