It’s Time For Value-Based Payment In Oncology

Value-based health care has risen to the top of the health policy agenda, as public and private payers search for ways to improve outcomes. The value principle---reimbursing hospitals, physicians, and other health care providers for quality or quality improvement that also help lower costs---aligns incentives between payers and providers. It’s time to apply this principle in oncology. Background Medicare implemented value-based payment for hospitals in 2012. Reimbursement is based in part on how well the hospital performed on three sets of measure: process of care, patient satisfaction, and mortality. About 1,231 hospitals saw their payment rates increase, and 1,451 saw them decrease in 2013. Medicare’s separate readmission policy financially penalizes hospitals for excessive readmissions for patients who entered the hospital with heart failure, pneumonia, or a heart attack. Recently, the federal government reaffirmed and strengthened its commitment to value-based payment by promising that 85 percent of all Medicare fee-for-service payments will be based on quality and value in 2016. The private sector is also embracing the idea. For example, Blue Cross Blue Shield of Massachusetts pays bonuses to a select group of providers if a broader set of quality targets are met. UnitedHealthcare’s total care provider reimbursements tied to value-based arrangements have nearly tripled since 2011 to $36 billion, and are expected to reach $65 billion by the end of 2018. One of the...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Equity and Disparities Health Policy Lab Payment Policy Quality cancer care oncology outcomes value based care Source Type: blogs