The world of U.S. healthcare is rapidly changing. One trajectory is the shift towards payers asking providers to move from volume-based care (that is, fee for service) to a value-based reimbursement structure (that is, fee for value).
In theory, this shift towards a value-based reimbursement system brings benefits for the patient, as well as the healthcare provider and the payer. This is based on the economic assumption that value-based reimbursement nudges healthcare providers to provide optimal care at the lowest possible cost. From the patients’ perspective the outcome is higher quality of care at a better cost.
Essentially, value-based care models focus on patient outcomes together with assessing how well healthcare providers improve quality of care. This is against specific measures, like reducing hospital readmissions; utilizing certified health IT; and improving preventative care.
A strong driver for this change has been the U.S. Department of Health and Human Services, which has the aim of linking half of traditional Medicare payments to a value-based reimbursement model by the end of 2018.
Given that this economic initiative requires healthcare providers to make key changes in the way they provide care, new forms of organization are entering the health economics space. There is also uncertainty emanating from this disruption.
For instance, many providers remain unsure of how to implement new contracts within their organization. The idea behind Payformance Solutions is to address the challenge by giving providers and payers the technical tools needed to “design, evaluate, build, measure and negotiate value-based reimbursement contracts.”
This needs to take place within an economic model that aligns payers and providers to have similar financial goals, and for these to meet with effective clinical outcomes for patients.
Payformance sets out to act as a neutral, unbiased third-party, bridging the so-termed trust gap between providers and payer and to foster a collaborative relationship. This is through bespoke software-as-a-service technology.
This is summed up by Lincoln Smith, president and CEO of Altarum, who said in a statement: “The health system’s evolution towards value-based care provides all stakeholders with a valuable opportunity to better align reimbursement with patient outcomes.”
Adding: “Payformance Solutions…is driving this much-needed transformation by helping payers and providers evaluate and implement the alternative payment models that will enable them to produce better outcomes and lower costs for patients.”
