by Mark A. Ridenour of the Ridenour Group, Consultant to the Ohio Optometric Association
Change in delivery and payment systems within healthcare today seems to be ever-present and accelerating. Some of this pace is dictated by deadlines within the Affordable Care Act (ACA), but much is fueled by a broad recognition of the urgent need for fundamental improvements in how health care is accessed, delivered and financed. The results to date speak for themselves. As all players strive to position themselves for tomorrow’s environment, multiple transformations can make it all very confusing. This blog series will identify the current status of several impactful transitions now underway and why you should care.
Most modifications in healthcare delivery systems are associated with changes in reimbursement. A common phrase used to describe the shift in payment systems is “from volume to value”. This speaks to the efforts to move from rewarding providers for the number of services performed via a typical fee-for-service form of payment, toward one which rewards outcomes. This can take many forms including pay-for-performance bonuses based on patient quality markers, to the avoidance of emergency room visits in a population, to a more direct shift of financial risk to the provider via bundled payments or capitation. A generalization of this trend would be a greater investment in primary/preventive care with the expectation of improved health, and the avoidance or delay of some of the costs of illness care. These types of payment system changes are embedded in all the delivery system transformations taking place across the country.
“An Evolving Health Reform Landscape” is a four-part series.