The complexity and frustration of the current national healthcare reimbursement system demands creative innovations. Healthcare providers and hospital systems, patients and payors are all struggling with misaligned clinical/financial incentives and the lack of financial predictability in healthcare. This is not a new problem. As far back as 1984, a few visionaries, including esteemed heart surgeon Dr. Denton A. Cooley, recognized this and pioneered the idea of bundled payments, resulting in making the highest quality cardiovascular care more accessible, financially predictable and affordable for everyone. At that time, our company forged a partnership with Dr. Cooley’s program to innovate, creating the processes and software to develop a premier program for cardiovascular bundled pricing and care.
Fast forward to 2015, and it’s more than a need; it’s a necessity. CMS has propelled healthcare providers into value-based, reimbursement programs, such as the Bundled Payments for Care Improvement (BPCI) initiative and the Comprehensive Care for Joint Replacement (CJR) Model, which is a five-year program anticipated to commence Apr. 1, 2016. Innovation will be critical as healthcare providers adapt to CMS’s mandate to participate in either the Merit-Based Incentive Payment System (MIPS) or an alternative payment model (APM), beginning in 2019.
The future demands new ideas and approaches as we navigate the transition from volume-based, fee-for-service to value- based reimbursement. Change is never easy but through innovation, the convergence of the best clinical outcome with the best financial outcome will align incentives of the payor, provider and patient, and transform healthcare for everyone’s benefit in the future.