Value-Based Reimbursement Structures

Value-Based Reimbursement Structures Wednesday, July 3, 2013

Value-based reimbursement models aim to improve quality and reduce costs by creating incentives for providers to deliver high-quality rather than volume-driven care. Federal and State programs are implementing policies and payment structures that reflect a movement away from the traditional fee-for-service system.

The featured Innovations describe three programs that implemented value-based reimbursement policies at the State level. One program offered health plans a capitated fee to deliver health care and social services to Medicare/Medicaid dual eligibles; a second adjusted individual hospital payment rates based on specific performance metrics; and a third program rewarded individual hospitals for reducing hospital-acquired conditions.

The featured QualityTools provide resources that help health care administrators and providers prepare for performance measurement and reporting to the Centers for Medicare & Medicaid Services, as well as a toolkit that offers guidance for implementing health care-associated infection prevention programs.

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