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Healthcare in the US is shifting from fee for service to value based payment with an emphasis on quality. The US Department of Health and Human Services (HHS) is facilitating this transition by moving Medicare toward payments tied to quality and value beginning in 2019. Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medicare providers will receive financial incentives to improve the delivery of healthcare services and consumer health outcomes. Value-based payment (VBP) programs tie healthcare provider compensation to measurable improvements in quality of care, patient health outcomes, patient experiences, and cost, often in a risk-bearing relationship.
While health plans have maintained and analyzed provider data to strategically set up their networks for many years, this shift from volume to value-based care is making provider data management even more important. In the traditional fee-for-service (FFS) model, health plans take on risk and historically have focused on managing healthcare and the delivery of healthcare services. To support value-based payment (VBP) models, health plans must begin to collaborate with providers and shift this focus to managing overall health and ultimately better outcomes.
Health IT and data strategies can help both health plans and providers in the journey toward increasingly higher levels of value-based care. The Johns Hopkins ACG® System can help; with multiple data sources from claims, lab and Electronic Medical Records (EHR), the ACG System can help payers and providers identify and address risk.