Value-Based Care

 


In recent times, the US health system has developed and implemented new payment programs to incentivize quality care provided to patients at a lower cost. Physicians are now, for example, expected to meet criteria in Medicare’s Merit-based Incentive Payment System (MIPS) in order to stop future decreases to their Medicare reimbursement.

To ensure pathologists can participate and succeed in new value-based care models, the CAP develops tools and provides information to prepare pathologists for new value-based programs under private and public payers. The CAP seeks to empower and strengthen the readiness of its members participating in value-based care models such as the new Merit-based Incentive Payment System. In addition, the CAP advocates with federal and state lawmakers to ensure that pathologists are fairly compensated in new value-based care models implemented by public and private payers. The CAP’s work includes education programs through timely webinars and at CAP meetings, practice management tools, and the development of the Pathologists Quality Registry.

To help pathologists gain a better understanding of value-based care terminology, our Value-Based Care Glossary defines some frequently used terms regarding federal initiatives and other key programs and concepts related to health care delivery system reform.

For the Medicare program, the CAP has developed quality measures that pathologists have reported to earn bonuses and stop penalties. These measures, and new measures developed by the CAP, further will be utilized in the Pathologists Quality Registry for reporting to meet MIPS and Quality Payment Program requirements mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Learn more about MACRA by viewing this infographic and webinar.

The Centers for Medicare & Medicaid Services also developed a tool for physicians to check eligibility for MIPS. Are you included in MIPS?

Alternative Payment Models (APMs)

Accountable Care Organizations (ACOs) and other alternative payment models (APMs) continue to grow as health system reform continues under MACRA and in the private sector. To further goals of ensuring pathologists role in coordinated care and APMs, the CAP and its Council on Government and Professional Affairs developed and drove legislation requiring ACOs to establish Clinical Laboratory Advisory Boards (CLABs) led by pathologists. CLABs rely on the pathologist medical director to help the ACO ensure appropriate testing. Learn how the CAP supports state enactment of model legislation to require ACOs to establish clinical laboratory advisory boards.

Value-Based Business Tool-Kits

Access a set of value-based business toolkits, business management tools for pathology practices that will help you better understand your practice and its market and adapt to the changing health care industry.

 

Value-Based Care (VBC) Glossary