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Payers and Value Management

Payers measure provider performance and direct patients to highest-value providers.

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Payers are demanding that healthcare reimbursements be linked to high quality clinical outcomes.

This has prompted the industry to start examining new types of payment models, such as bundled payments, medical homes, and quality-based incentive payments. The U.S. Department of Health and Human Services (HHS), the payers of Medicare and Medicaid, have reported that the agency would like to tie 50% of payments to the new payment models by 2018 and factor quality into 90% of the traditional Medicare payments by 2018.

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