Value-Based Care


Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare healthcare coverage. These programs are part of CMS’s larger quality strategy to reform how health care is delivered and paid for. Value-based programs support the government’s three-part aim:

  • Better care for individuals
  • Better health for populations
  • Lower cost

Value-based programs are important because they’re helping the U.S. move toward paying providers based on the quality rather than the quantity of care they give patients.
Check out what the acronyms stand for: DOWNLOAD PDF

As we move toward value-based care and improved outcomes, CMS and commercial payers are quickly unveiling new models of care and payment reform to reward success and penalize failure. Most of these models have been voluntary to date such as the Bundled Payments for Care Improvement (BPCI) initiative, Accountable Care Organizations (ACOs), and Patient-Centered Medical Home (PCMH). However, CMS announced the first mandated bundled payment in November, 2015, called Comprehensive Care for Joint Replacement (CJR). The mandatory bundles initiative is accelerating with the newly proposed rule for cardiac and hip fractures announced in July, 2016. CMS has already reached the goal to get 30% of all healthcare services into value-based models by the end of this year and 50% in just two years. This is not just a cost-cutting model; the bar to increase quality will become more difficult each year.

Improving outcomes, lowering costs, and reducing complications.

Secretary Burwell

“Our first goal is for 30% of all Medicare provider payments to be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide – and to do it by 2016. Our goal would then be to get to 50% by 2018.”

– HHS Secretary Burwell, Posting January 2015