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    Features

    Designing from Finish to Start

    When developing products for a value-based environment, it can be helpful to consider the end result first.

    Designing from Finish to Start
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    Steve Maylish and Vicki Caiati05.03.18
    In 2007, the Institute for Healthcare Improvement developed the Triple Aim: to simultaneously improve patient experience and population health, while also lowering cost per capita. This influenced the 2010 Affordable Care Act (ACA). In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed and in October 2016, the Centers for Medicare and Medicaid Services (CMS) issued the final rule to implement MACRA. Its intent is to reduce healthcare spending and overall utilization by incentivizing providers to improve quality and outcomes. Today, our healthcare model is in the process of changing from volume based to value based. In 2018, if you’re designing a product with a fee-for-service model in mind, you may be on very thin ice.

    Currently, about 30 percent of all healthcare payments in the U.S. are tied to alternative payment models (APMs), according to an Oct. 30, 2017, report from the Health Care Payment Learning & Action Network. In just over five years, APM payments are expected to be close to 80 percent. MACRA and ACA are driving APMs and value-based care. Starting in 2019, MACRA will pay Medicare reimbursement to clin

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