Leadership Insights: The Impact of Value

2016. The Year of Value.

2016 is here and leaders are quickly positioning for the new era and role of post-acute care in the nation’s health care redesign.

Value-based care, value-based reimbursement and value-based purchasing, are terms that have been buzzing throughout all provider types, keeping leaders cautiously awaiting their impact. No matter how tired we are hearing these terms, value-based healthcare is now a reality.

The Center for Medicare and Medicaid Services (CMS) has informed post-acute care providers that time for change is here and the implementation of “value-based” systems will rapidly impact the provision of services and how business is conducted. Through new CMMI payment model designs that are rapidly hitting all post-acute care markets in the nation, including ACOs, Next Gen ACOs, BPCI, CCJR to name a few; legislative actions such as the Hospital Readmission Reduction Program (HRRP) and the IMPACT Act, as well as numerous memorandums outlining post-acute care value-based purchasing and expectations, CMS has outlined that value-based care is here to stay.

Success in this new era of value-based care requires leadership to assess where they are on the path to transitioning to value-driven care, both in the fast growing government reimbursement models, as well as the current local marketplace dynamics. When assessing your organization’s readiness for change, it is important to determine your organization’s clinical capabilities, clinical competencies, physician engagement strategy, acute care engagement strategy. Other important factors include your organization’s capacity for volume and its ability to encompass a standardized care transition and communication process across all care continuums. Equally important is completing a detailed review of your organization’s performance/outcome data, benchmarking it to industry standards and expectations. Operational performance/data metrics will determine your success and sustainability in the new care and payment models. As we know, Data = Quality!

2016 Immediate Value-Based Leadership Priorities
  • Assess current operational status for transition to value-based care.
  • Align organizational data – clearly depicting your organization’s ability to meet and exceed quality expectations in the new economic and clinical models.
  • Reduce preventable hospitalizations (the first quality measure tying organization performance to reimbursement).
  • Improving your Five Star Rating. This is the number one consideration for inclusion in the new payment models.  The Five Star Rating system is expected to have new changes in 2016 and 2017, ultimately affecting your reimbursement, as well as your ability to be a participant in the rapidly growing value-based payment models.
  • Identify and understand the new payment models’ impact to your organization and how they effect your current marketplace (e.g., ACOs, Next Gen ACOs, Bundle Payment Care Improvement models, CCJR, etc.).
Transitioning to the new clinical and economic models requires leaders to prepare their organizations for transition.  Leaders will need to think strategically about the current status of their organization, the organization’s ability to change, what is needed to be accomplished over time to be successful operating in the new health care paradigm.

Are you ready for value-based care? Contact us to learn more.


Lisa Thomson
Chief Marketing and Strategy Officer
Pathway Health