Value-based reimbursement has been a hot topic recently with the updated information regarding CMS’s Quality Payment Program released in October.  It seems that the phrase “when CMS institutes, commercial payers follow suit” has come to fruition when commercial insurer Humana announced Wednesday they are distributing over $93 million related to quality metrics.  Nearly 4,500 provider organizations participated in Humana’s Provider Quality Rewards Program.  According to Humana those providers placed in value-based reimbursement contracts utilizing NCQA HEDIS measures demonstrated patients with overall improvement in scores, and additional progress in the areas of cost and chronic care management.

Dr. Roy Beveridge, Humana’s Chief Medical Officer, stated “as the industry continues to shift toward value-based payment, programs such as these are proving that care tied to quality metrics can have a meaningful impact on a patient’s health.” He also noted, “Physicians are benefitting, too, by being paid for the complex care they are delivering.”

MACRA and the Quality Payment Program were passed by 92 Senators and 392 Representatives according to Andy Slavitt, the Acting Administrator for CMS.  As a bipartisan piece of legislation, it is unlikely that we will see regression, but rather progression with value-based reimbursement, as evidenced by this recent Humana funds dispersion.  Value-based reimbursement is catching on.


Still confused about MACRA, MIPS, and the QPP?  Contact our Regulatory Compliance Advisor, Kathryn Ayers Wickenhauser, for more guidance at Kathryn.Wickenhauser@ScanSTATTechnologies.com

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