It is expected that FFS payments from both Federal and commercial payers will decrease by about 24 percent by 2017 $ Group Practices & Value-Based Federal/Commercial Policies!

Where healthcare financing is heading and how group practices can get there? Fee -For-Service Value-Based

The reimbursement results from federal and commercial Payers offering risk based arrangements What are the tools required? $

Volume-based, fee-for-service (FFS) payment models are unsustainable Providers have little experience operating in a risk environment Shifting landscapes of healthcare finances 90 percent of Medicare payments to be tied to value-based models by 2018 MSMGs and IDSs support this transformation MACRA of 2015 mandates healthcare providers to take on payment risk over the next several years $

Group practices would need at the least 2-4 years to start accepting these risk based systems Commercial / Federal Payment Models & Regulations Reimbursement Revenue & Payment Model Organizational demographic Payer-driven impediments and provider-driven issues All risk arrangements to increase more than twofold by 2017

Popular payment models: FFS, shared risk, shared savings/ACO, partial capitation, bundled payments…. Commercial Setting challenges Lack of access to full administrative claims data Lack of transparent cost/ quality data feedback Insufficient information technology (IT)/analytics infrastructure Bundle Payment will be playing a larger role by 2018

Popular payment models: FFS, Medicare Advantage, Medicaid managed care, Accountable Care OrganizationsAccountable Care Organizations (MSSP/Pioneer/Next Generation)… Federal Setting Impediments Ineffective attribution methodology Lack of a standardized data submission and feedback process Business of medicine is being used to change the delivery of healthcare, and it’s being driven directly by the government.

Value-based payments improve care and reduce healthcare costs Value-Based Reimbursements Transition from FFS to value-based payment Payer types vary in accordance to geographic locations Alignment between Federal and commercial settings on value-based payment

With right automation tools group practices will be able to streamline their cash flows, determine precise eligibilities, collect patient payments up front,determine precise eligibilities and fill clean claims to the payers. Few ways group practices can make this transition smoother Getting educated on tracking the quality metrics Setting up a system that can help shrink AR delaysshrink AR delays Developing reporting solutions that will help them communicate it to the payers

Revised financial benchmarking and risk-adjustment methodologies What tools do providers need? (Value-based system) Tools both the Federal government and commercial payers can provide Operational in nature Standardized data submission/feedback process Meaningful patient engagement incentives

Apart from these, the system must develop a fine collaboration between the government, the payers, group practices and the patients; this should smoothen out hindrances and make the transition from fee-for-service into value-based system a success on all fronts.

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