Value-Based Care Models & Reimbursement in 48 States

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Value-Based Care Models & Reimbursement in 48 States

The data till February 2019 shows that Care programs and Value-based reimbursement are now implemented by nearly forty-eight states.

A study by state healthcare payment programs has revealed that almost half of all these initiatives for value-based reimbursements are multi-payer. There are only four states that have initiated any value-based payment in any form.

A vital step

The public often tends to remain focused on the role the federal government is playing to catalyze healthcare payment reform. However, the truth is, essential steps are being taken at the state level, which is of immense significance.

Value-based payment models are now being explored by many managed Medicaid programs. States are now focusing on ensuring that a transformation occurs in healthcare payment strategies, which will prove to be highly beneficial. Significant progress is being made in the field.

The data from 2017 till February 2019 reveals that six states have put proper value-based reimbursement strategies into action for four years or more. At the same time, about 34 states have implemented the strategies for two or more years. The program is in its initial stage of development in eight states. There are very few states that have not made any strides in the value-based reimbursement strategies.

The study has revealed that many states are now moving towards value-added reimbursement strategies and are thinking of different plans for the same. The purpose is to make people more inclined towards these programs, steering them away from the concept of fee-for-service.

Other states are also now looking to adopt accountable care organizations or episodes of care programs. The latter uses bundled payments and thus is meant to encourage the practice of value-based care.

About 18 regions have put the plan of Comprehensive Primary Care Plus into action. This model revolves around multi-payer advance primary care and serves to bring about improvement in primary care via value-based reimbursement.

CMS started allotting SIM grants to the states who wanted to implement the strategy of multi-payer healthcare payment in 2013. A test or design grant is issued to the state depending on whether the state had planned and designed the strategy to transform healthcare or was now in the stage of implementing it.

The design grant of about $1-3 million has been received by nearly 20 states. This is sufficient to cover the finances of the program for almost a year. On the other hand, about 17 states have used test grants to get millions of dollars to implement the strategy.

According to reports, the second round of SIM grants was in progress for about eleven states. The spending on Medicaid increased in other models following the first year.

However, as has been pointed out by CBS, this was hardly unexpected. It takes some time for consumers and providers to get accustomed to such changes. Some time is required for the states to understand the importance of savings and the need for improvement in care quality.

However, it cannot be denied that the states have done considerable work to change the healthcare industry to a significant extent.

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