Understanding Some Key Aspects of Value-Based Reimbursement

Value-Based Reimbursement pic

Value-Based Reimbursement
Image: mckesson.com

Connecticut’s Great Point Partners oversees a wide range of investments in the health care sector.

Value-based reimbursement, sometimes called “Pay for Performance,” refers to the type of payments received by certain healthcare providers from CMS payers. These payments are based on value rather than volume. That is, providers are paid, not based on how many procedures they perform or services they provide, but rather based on certain pre-defined quality measures.These measures include factors such as patient satisfaction, outcomes, and reduced operating costs.

Two important components of this system are Accountable Care Organizations (ACO) and the Medicare Shared Savings Program. An ACO is a voluntary association of doctors, hospitals, and other providers that work together to optimize patient care, with the goal of saving money and receiving incentives from payers. The Medicare Shared Savings Program is one type of ACO that is established for providers who receive payments from Medicare.


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