Enacting value-based care payment models has been a priority of payer and provider organizations in recent years, but the implementation has been uneven, with care centers serving underprivileged or vulnerable populations being left in the lurch. Helping close the gap is pivotal to reaching the US Centers for Medicare and Medicaid Services (CMS) goal of transitioning to value-based payment models for the majority of Medicaid and Medicare reimbursements.
According to Brandon Clark, “Because of the familiarity of this fee-for-service model, the biggest barrier to value-based change is often the safety of the status quo. It can be both risky and frightening to fundamentally change a business model that has been proven functional, even when margins are less than desirable. Until recently, few felt the need to leap into the uncharted waters of value-based care. However, the COVID pandemic brought a sharp reminder that no business model is risk-free, with traditional office visits (and the associated billing revenue) falling to near-zero levels at various times across 2020 and 2021. This post-COVID trauma, combined with the CMS mandate, have together driven a renewed sense of urgency on the merits of value-based care.”
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(Source: Managed Healthcare Executive, July 6th, 2023)