Medicaid & Value — More Value-Based Contracting With Health Plans = More Value-Based Reimbursement For Provider Organizations

The evolution of health and human services away from a focus on cost-based/volume-based reimbursement – and the growing expectation that cutting volume means better care coordination – is changing both the successful business model and the market role of many service provider organizations. For a great example of this payer induced pressure, executive teams need look no further than state Medicaid programs.

The Patient Protection and Affordable Care Act (PPACA) resulted in an increase in the number of state Medicaid programs implementing care coordination and value-based payment initiatives – with the goal of improving the quality of consumer care . . .