C-suite leaders face challenges including implementing value-based care, establishing population health efforts and creating mutually beneficial partnerships.
As value replaces volume in the healthcare industry, hospitals are looking for partners to become more efficient and nimble under new care delivery models and payment arrangements.
Despite their original reservations, many hospital leaders have embraced Medicare's mandatory bundled-payment program for total joint replacements. New CMS data show nearly half of participating hospitals met their cost and quality targets and received financial rewards in 2016.
The CMS has launched an initiative that it hopes will lead to less provider regulation, allowing doctors to spend more time with patients.
While the future of the Affordable Care Act is still uncertain, a number of initiatives that began under the law have shown the kinds of results that transcend politics and will keep the focus on value over volume.
Healthcare's shift from paying for volume to paying for value will require a "total restructuring" of the industry, said Cleveland Clinic CEO Dr. Toby Cosgrove.
Although most value-based pay models focus on primary care services, providers and policy experts hope the recent financial success of accountable care organizations targeting dialysis patients will lead to more disease-specific pay models.
Physicians hoping to succeed under new alternative payment models face a significant hurdle, and one that's out of their control: vendor readiness.
Humana set a goal of having 75% of its individual Medicare Advantage members covered under value-based relationships by 2017. The company now has 1.8 million lives, or 85% of its MA population, in value-based care. As a result, the insurance giant has seen costs decrease by 19%.
While there is increasing awareness that what creates health is more than clinical excellence, there is still much work to do.
The CMS is asking for feedback on ways to promote competition in the market, enhance provider choice, encourage patient feedback and improve price transparency.
The CMS said more work needs to be done to get the word out among providers about MACRA since there are still awareness gaps around the requirements of the law nine months into its rollout.