Top three value-based reimbursement challenges in 2015

The healthcare industry may look back on 2015 as a "watershed year," during which the switch from volume to value solidified. That's according to Farzad Mostashari, MD, former U.S. National Coordinator of Health Information Technology and current CEO of Aledade, an accountable care organization (ACO) services firm.

Much of this wide-scale movement toward value began in January, when U.S. Secretary of Health and Human Services Sylvia M. Burwell set aggressive goals and a timeline for value-based payment models—effectively tying 30% of fee-for-service payments to alternative payment models by the end of 2016 and 50% of such payments to alternative models by the end of 2018, says Mostashari. Burwell’s announcement signals that the Centers for Medicare & Medicaid Services will use all of its policy powers to achieve these benchmarks, he says.

Burwell's announcement also signaled to the private sector—which includes commercial payers, provider organizations, and purchasers—that it's time to more aggressively shift from volume to value. “Almost more than any regulatory change or payment change, it’s really that seriousness of intent that was the most significant change in reimbursement in 2015," Mostashari says.