DESIGNING A PATIENT-CENTERED HEALTH CARE SYSTEM

FROM VOLUME TO VALUE

1 www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-07-16.html2 www.washingtonpost.com/blogs/wonkblog/files/2013/03/2013-Quality-Benchmarks.pdf3 www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-reimbursements-from-volume-to-value.html

HEALTH CARE DELIVERY AND PAYMENT HAVE COME A LONG WAY… BUT ARE THEY TRULY PATIENT CENTERED?

OCTOBER 2004CMS begins paying hospitals a higher annual update to their inpatient payment rates for reporting designated quality measures.

FEBRUARY 2009 American Recovery and Reinvestment Act promotes adoption and meaningful use of interoperable health information technology (HIT) and quali�ed electronic health records (EHR).

JANUARY 2012 CMMI begins testing new payment models—largely tied to pre-existing quality measures.

JULY 2013 CMS reports $87.6 million in savings and enhanced quality performance for 15 clinical quality measures in Pioneer ACO program.1

JANUARY 2015 HHS goals set: 30% of traditional Medicare payments to be tied to quality or value through alternative payment models by the end of 2016; and 85% of these payments to be tied to quality or value by 2016.3

DECEMBER 2006 Implementation of Physician Quality Reporting Initiative and Hospital Outpatient Quality Reporting Program, leading to development of 255 new process measures for physicians.

MARCH 2010 ACA establishes the Innovation Center (CMMI) to test new payment models aimed at preserving/enhancing quality of care while lowering cost.

OCTOBER 2012 Hospital Readmission Reduction Program begins imposing �nancial penalties on hospitals with excess Medicare readmissions.

2014 By year-end, one third of Pioneer ACO model participants dropped out after expressing concerns over quality metrics.2

APRIL 2015 Passage of MACRA, creating greater incentives for physicians to move from volume to value.

We need to focus efforts on driving higher-quality care through a patient-centric health system that listens to the patient and prioritizes outcomes over processes.

Where

do we go

from

here?