Now or Never: Making the Commitment to Value-Based Reimbursement

摘要

The market has spoken. Healthcare is too fragmented, inconsistent, redundant, and expensive. With a slew of value-based reimbursement reforms marching across the healthcare landscape, a fundamental shift is beginning to take hold. In their feature article, Henkel and Maryland point out that Ascension Health in St. Louis, Missouri, realized that a payment inflection point was bearing down faster than anticipated, stimulating them to make a bold commitment to building a value-based system. Similarly, Kuhn and Lehn relate how Banner Health Network (BHN), in Phoenix, Arizona, seized the initiative by volunteering for the Pioneer accountable care organization (ACO) program. Understanding the magnitude of the undertaking, both organizations realized that a significant investment was needed to transform the management of patient communities. Taking action ahead of competitors is risky, as any early adopter can attest, and it is not without setbacks and lessons learned. However, the accelerating pace of change is demanding action as payment innovations, which are beginning to yield cost and quality results, redefine the revenue model. Although the levels of these payments are currently marginal, the rise of consumerism brought about by exchanges and narrow networks is spurring a redesign of the care model. A tipping point will come when the bulk of revenue shifts from volume to value, as we discovered at Carroll Hospital Center in Westminster, Maryland, when we volunteered to participate in an experimental payment program.