{"id":11467,"date":"2020-07-02T21:47:57","date_gmt":"2020-07-02T16:17:57","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=11467"},"modified":"2026-05-11T11:14:22","modified_gmt":"2026-05-11T11:14:22","slug":"transition-to-value-based-reimbursement-is-essential-for-health-disparities","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/transition-to-value-based-reimbursement-is-essential-for-health-disparities\/","title":{"rendered":"Transition to value-based reimbursement is essential for Health disparities"},"content":{"rendered":"

Value-based reimbursement inspires clinicians to care for the whole person, who is essential to addressing health disparities confirmed by claims data from the COVID-19 crisis, CMS says.<\/p>\n

Health disparities confirmed by Medicare claims data for the period of the COVID-19 crisis underscore the need to transition to value-based reimbursement,\u00a0according to\u00a0CMS.<\/p>\n

Health disparities evident in the initial claims data from the pandemic also suggested the impact of\u00a0social determinants of health, particularly socio-economic status, CMS reported.<\/p>\n

Beneficiaries joined in both Medicare and Medicaid had the second-highest overall hospitalization rate behind end-stage renal sickness patients, the claims data showed. These double qualified adults had 473 hospitalizations per 100,000 beneficiaries.<\/p>\n

The initial data confirmed not only \u201clong-understood disparities in health outcomes for racial and ethnic minority groups and among low-income populations,\u201d but also the essential transition to value-based reimbursement<\/a>, the federal agency stated.<\/p>\n

Healthcare providers have generally been\u00a0hesitant\u00a0to accept more downside financial risk, and large\u00a0financial losses\u00a0incurred during the COVID-19 crisis may make more providers pause before jumping into new risk-heavy models.<\/p>\n

Over half of care organizations in the Medicare Shared Savings Program have already shown that they may quit the program due to concerns that COVID-19 could lead to massive financial losses. ACOs have got flexibilities in the program during the pandemic, including the help of shared losses back to January 2020.<\/p>\n

The capability for ACOs to stay in their same risk track next year will help sustain contribution in the program, according to\u00a0the National Association of ACOs. But financial concerns remain due to COVID-19.<\/p>\n

\u201cThe disparities in the data reflect longstanding challenges facing minority communities and low-income older adults, many of whom face structural challenges to their health that go far beyond what is traditionally considered \u2018medical\u2019,\u201d said CMS Administrator Seema Verma.<\/p>\n

It is clear that the fee-for-service system is unsatisfactory for the most vulnerable Americans because it limits payment to what a doctor\u2019s office receives reimbursement. The transition to a value-based system is not an urgent requirement. But if it implemented correctly then it encourages clinicians to care for the patient and address the social risk factors. This will help our beneficiaries\u2019 quality of life.<\/p>\n

Other key data points:<\/h2>\n