Know Your Earning Potential with Bundled Payments and Value-based Care


The increase in value-based care initiatives tied to bundled payments indicates big changes in the healthcare industry that affect the way patients receive care and providers measure success. As technology and medicine continue to advance, so does the way doctors engage patients to create meaningful relationships resulting in better patient outcomes. Traditionally in the United States, payment for healthcare treatment has been based on a fee-for-service model – the more patients receiving service, the more reimbursement for the provider, but that model is quickly changing.

Hospitals, practices, and even clinicians are now paid according to value-based care reimbursement models. Quality and outcome standards are used to determine pay rates in response to a need for care that improves health rather than demands services. Organizations, and even individuals, are rewarded for meeting target costs and improving patient satisfaction and outcomes, while penalties are assessed for those unable to meet standards set by CMS.
Sequence Health offers a suite of solutions allowing doctors and patients alike to benefit from new standards in efficient care delivery, effective patient experiences, and payment models that make sense under today’s value-based care programs.

What Is Value-Based Care?

Historically, doctor’s services are charged on a per-procedure or appointment basis. As such, many doctors feel pressured to perform a long list of procedures and tests that may or may not be necessary. In time, this cycle leads to longer patient hospital stays, more patients at one time, and often unnecessary ancillary testing.

Instead of putting pressure on healthcare providers to perform potentially-needless procedures, value-based care focuses on medical decisions with the patient’s health and best interests in mind. When properly incorporated, this approach to medical treatment can ultimately reduce visit frequency and in-patient procedures while increasing satisfaction, rewards, and patient-reported outcomes.

CMS Leads the Transition to Value-based Care

For facilities that work with Medicare, complying with value-based mandates may or may not be required by CMS, or Centers for Medicare and Medicaid Services. CMS currently oversees a number of value-based bundled payment models, including CJR that affects orthopedic practices in 67 different regions across the country, and will be rolling out the new MACRA incentive-based payment system in 2017.

Comprehensive Care for Joint Replacement (CJR)

Commonly known as CJR, Comprehensive Care for Joint Replacement seeks to address one of the most common orthopedic inpatient procedures for Medicare patients: knee and hip replacements. Designed in an effort to standardize quality and cost of care, CJR replaces fees for related services with a bundled payment method, regulating the procedure, recovery duration, and more.

Medicare Access and CHIP Reauthorization Act (MACRA)

Passed in 2015, the Medicare Access and CHIP Reauthorization Act, or MACRA, is an incentive-based payment system to be associated with Medicare services. Utilizing two tracks for payment, Merit-based Incentive Payment System (MIPS), and Alternative Payment Models (APMs), MACRA is intended to replace three existing quality reporting systems with a streamlined, more effective alternative.

Leveraging the Sequence Platform

By treating healthcare technology as a tool, not an industry, it’s possible to increase quality of care while reducing paperwork and honing the focus on paying for what works rather than what can increase billing.

Sequence Health can streamline this transition, easing the workflow impact of physician teams and making workflow management, patient engagement, and care plan adherence painless. With our unique technology related to hospital and provider management, our suite of solutions alleviate your burden, increase efficiencies, and simplify your care team’s day-to-day routine.

Are you prepared to deliver and document value-based care to ensure you maximize your earning potential under reimbursement models that feature bundled payments?

Contact Sequence Health today to learn more!