Medicare Value-Based Payments Explained

Medicare Value-Based Payments (also Called Alternative Payment Models) to Hospitals Fall Into 3 Main Categories:
1 - Pay for Performance (P4P): There are 3 Sub-Types of Pay-for-Performance
--Value-Based Purchasing: Fee-for-Service with $1.5B at Stake in Quality Bonuses to be Paid-out by Penalizing those Hospitals with Poor Quality. Budget Neutral for Medicare.
--Readmission Reduction: Fee-for-Service with 3% Penalty for Readmissions for 6 Conditions, Only Downside for Hospitals, No Upside. Medicare Saves.
--Hospital-Acquired Conditions (e.g. Catheter-Associated Urinary Tract Infection): Fee-for-Service with 1% Penalty, Only Downside for Hospitals, No Upside. Medicare Saves.
2 - Bundled Payments: Fixed Payment for 32 Different Episodes of Care, Voluntary Program
--Fixed $ Amount for Hospital + Doctor + Post-Acute Care
--Program is Shrinking: Participating Hospitals from 830 to 715
3 - Shared Savings: Accountable Care Organizations (ACO) - Fixed Payment for a Population of Patients for a Certain Period of Time (aka 'Capitation'), Voluntary
--517 ACOs Currently Care for 11.2 Million Medicare Beneficiaries - 28% of Total Traditional Medicare Population, BUT 56% of Hospitals Plan on Ending Their ACO
Sources:
Advisory Board Company Slide Presentations Previously Shared Publicly on the Internet.
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[@natachaharley6800]

Wow! Very clear. Not afraid anymore to interview for a position with VB reimbursement

[@ahealthcarez]

Thank you for your feedback.

[@archfruylant5373]

Thank you for breaking it down Doc. Reading it from a journal won't come out as clear as this.

[@ahealthcarez]

Thanks so much, Arch. Appreciate you watching.

[@carolinagarza3673]

Thank you so much for this video!!! This has made it so easy for me to understand now. I have been struggling for days, research, reading books etc., and in just a few minutes with your video, I understand.

[@ahealthcarez]

Super! Thank you for watching.

[@haotianwu5135]

Thanks! This is the clearest video for VBP.

[@ahealthcarez]

Thank you for watching and for your feedback.

[@17thSonSchaefer]

Do you have a breakdown on shared savings (utilization) in MA and the flow of returned incentives to payers in group retiree funded vs fully funded MA under the payers?
I can see value added with Stars performance increasing benchmark premium funding and then increasing the share of savings created (4.5 star = 70%)
But on group funded MA plans, is that still the same as far as reporting to CMS - but different in funding dollars and where the rebates are shared? Trying to follow that as I have grey area in my understanding.
Part of this is trying to negotiate with a payer and knowing requirements and flow of dollars on MA, but group seems to add some hurdles.

[@manikandanbaluchamy5460]

Your videos are quite informative and keep doing the good work. I'm not sure if anyone has told you that your video camera keeps going in and out-of-focus in every now and then in most of the videos you've produced and it affects the eyes of the viewer a lot. It prevents the person from concentrating on the great content you produce. If you can do anything to fix it, that'll be wonderful. Thanks!

[@ahealthcarez]

Thank you for watching and for the feedback.

[@RaminR]

Another great video!! Thanks for the thorough explanation. Can you please do a video explaining the difference between traditional Medicare & Medicare Advantage plans ?

[@ahealthcarez]

Thank you for the suggestion. It is a great idea.

[@2MidnightSun2]

My god this was so confusing for me and you made it easier. THANK YOU!

[@ahealthcarez]

Super. Thank you for watching. Glad it helped.

[@RahulSharma-hp1dw]

Which model is best for a data driven telehealth business in the CCM/RPM space?

[@ahealthcarez]

Not sure. Good question.

[@jenp5754]

love this video. the link for sources isn't working. where can i find these?

[@ahealthcarez]

I know. The Advisory Board took down access to the online modules. It is unfortunate. Thank you for watching.

[@AlbertKatz]

This is great, would love to chat about bundled payments vs capitated agreements

[@ahealthcarez]

Thank you for watching!