Private insurers offering value-based programs will often provide reimbursement for novel technologies, such as RPM technology, that they otherwise might not provide coverage for. In other cases, providers are given an advanced payment that can be used by the care coordinator to provide services at their discretion and reimbursement is not tied to a set fee schedule.
For CMS-led value-based programs, reimbursement is tied to the Physician FFS Schedule, though providers may be able to take advantage of certain patient engagement and technology waivers for devices not covered under the fee schedule.
Some examples of value-base programs are:
Accountable Care Organizations (ACOs)
ACOs bring together different care providers, including primary care physicians, specialists, hospitals, and other health care professionals in order to better coordinate patient care. Doing so allows these organizations to operate more efficiently and manage patients’ long-term health, including chronic conditions, more effectively.
ACOs are rewarded when they meet or exceed certain benchmarks that are generally set around reducing cost while improving the standard of care. ACOs tend to be large in scale and are most effective at managing population health across entire communities or regions.
Patient-Centered Medical Homes
Patient-centered medical homes are structured in much the same was as ACOs, except patients in patient-centered medical homes have all aspects of their care organized by their single primary care physicians. The primary care physician is compensated for each patient that is under their care, as well as a share of any savings from reducing downstream costs.
Insurers offering such programs:
*This list is not intended to be exhaustive, as payers are continuously developing new value-based programs and experimenting with different models. Please contact representatives from your network if you are interested in finding out what value-based models are currently available through your insurers.