HHS Sets Goals for Shifting Medicare Reimbursements
Health and Human Services Secretary Sylvia Burwell has announced measurable goals and a timeline to move the Medicare program toward paying providers based on the quality, rather than the quantity of care, for patients.
This marks the first time HHS has set explicit goals for alternative payment models and value-based payments.
In a press release issued yesterday by HHS , the agency outlines its vision and goals for the next several years. The new goals as follows:
- Tie 30% of fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016
- Tie 50% of payments to these models by the end of 2018.
- Tie 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs.
To make these goals scalable beyond Medicare, Secretary Burwell also announced the creation of a Health Care Payment Learning and Action Network. Through the Learning and Action Network, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs. HHS plans to intensify its work with states and private payers to support adoption of alternative payments models through their own aligned work, sometimes even exceeding the goals set for Medicare. The Network will hold its first meeting in March 2015.
“Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people. This announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health care dollars more wisely,” Secretary Burwell said. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement.”
Putting this in perspective, the HHS announcement states that In 2011, Medicare made almost no payments to providers through alternative payment models. Today, such payments represent approximately 20 percent of Medicare payments. The new HHS goals represent a 50% increase by 2016.
- Perspectives piece published in the New England Journal of Medicine from Secretary Burwell
- CMS Fact Shee
- Fact Sheet on the goals of the Learning and Action Network