In an effort to improve patient care and outcomes, there is an ongoing transition away from the fee-for-service model in favor of value-based care. This is causing a fundamental shift in how reimbursements are calculated, creating new financial hurdles for healthcare systems throughout the US.
Unlike the relative simplicity of fee-for-service billing, the value-based care model ties reimbursement to how well providers support quality of care. Payers determine payment amounts by evaluating specific outcome metrics, such as reducing hospital re-admissions or improving preventative care. This shift in how reimbursements are calculated requires enterprise-level changes in tracking individual patients and implementing strong population health initiatives.