shift to quality-based reimbursement models in healthcare. The legacy fee-for-service structure, where healthcare providers are reimbursed for individual units of care such as lab tests, is giving way to what is known as value-based care, where providers are incentivized to keep costs as low as possible by keeping patients healthy.
The American Medical Association and KPMG recently conducted a survey that examined physicians’ knowledge of—and readiness for—the QPP and related programs. According to the survey, 70 percent of respondents have started preparing to meet the requirements of the QPP this year. However, only 23 percent of those who have begun preparing feel well prepared to meet the program’s requirements in 2017.
Barbouche says that despite the work Forward Health Group is doing to help its customers adapt to changes in how the government reimburses organizations that care for Medicare patients, he believes medical practices as a whole are currently not ready to navigate the shifting landscape.
Still, he believes that the CMS’s move toward value-based care could send an important signal to other leading health insurers.
“We think that what QPP represents is the start of a transformation,” Barbouche says. Medicare is “aggressively courting the Aetnas (NYSE: [[ticker:AET]]), Cignas (NYSE: [[ticker:CI]]), and others to match the same type of incentive programs. All of these programs are going to carry this idea of performance-based reimbursement. They’re not going to be focused on legacy fee-for-service.”
