A look at 4 value-based care programs

October 5, 2020 | Rivkin Rounds Staff | ACOs | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers

A September 30 article in Managed Care Executive, “Are we there yet? A look at 4 value-based care programs,” offered a snapshot of four value-based care programs being undertaken by the Centers for Medicare & Medicaid Services (CMS) and Blue Cross Blue Shield of Massachusetts. Rivkin Radler’s Chris Kutner was quoted in the article.

Chris gave his perspective on CMS’s Oncology Care Model and its successor, Oncology Care First. He noted that commercial payers want to expand value-based models to better predict the cost of care, but he also pointed out that claim systems were designed for fee-for-service reimbursement. “It’s a drastic change and challenging for payers and providers to operate on a bundled case rate or episodic payment structure,” Chris said. “Success hinges on oncologists being incentivized and enabled to deliver high-quality care alongside measurable cost savings.” He added, “Cancer care is extremely expensive, so I am encouraged that there are some emerging opportunities that stakeholders must examine in order to realize value in today’s oncology reimbursement models.”

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