11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters

July 2015 1-941329-81-0 PDF (30 pages)

Healthcare Intelligence Network

CMS's ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors have also pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare's per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours' building of a business case for its multidisciplinary care team to the John C. Lincoln ACO's deep dive into data analytics to identify and manage the care of high-risk, high-cost 'VIP' patients to 'beat the benchmark' to WellPoint's engagement of specialists in care coordination. This resource looks at the value proposition inherent in Medicare's recently announced Chronic Care Management codes and  includes many lessons to learn from the 11 models outlined in this quick reference.

Categories: healthcare

Table of Contents:


  • How Bon Secours Gets Paid for Providing Value-Based Healthcare
  • Humana Physician Quality Rewards Boost Population Health across Accountable Care Continuum
  • 3 Factors Driving Healthcare’s Transition from Volume to Value
  • Healthcare Strategy Group: 4 Factors Driving Resurgence of the PHO Model
  • WellPoint Care Coordination Compacts Establish Accountability, Clarity between Physicians and Specialists
  • BCBS Michigan Physician Value Partnership Translates to Quality Improvement, Cost Savings
  • Optum’s 3 Essentials for Shift to Value-Based Physician Compensation
  • WellPoint ‘Leaves No Primary Care Practice Behind’ on Road to Value-Based Payment Reform
  • Monarch Pioneer ACO to Specialists: If Care Coordination Role Fits, Wear It
  • John C. Lincoln’s Deeper Data Dive Improves ACO Performance, Quality
  • Medicare Chronic Care Management Code: Arnold & Porter Test-Drive Value-Based Healthcare Delivery Model
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  • About the Thought Leaders