CHI Health Partners has led initiatives to improve quality and reduce costs for more than 15 years. These efforts include work with the Medicaid Risk Product since 1999, managing high-risk Alegent Creighton Health employees since 2011, and continuing to build our infrastructure to offer value-based care more broadly. Value-based developments in 2015 include the new Aetna Whole Health Accountable Care Network and an expanded UnitedHealthcare agreement. We will continue to maintain our focus on value-based agreements with all payors.
A value-based payment (reimbursement) system is structured around achieving certain care quality goals for a given population of patients at a pre-determined cost. Value-based care focuses on providing the right care, at the right time, in the right place to achieve the best outcomes for patients at the most affordable cost.
With a value-based payment contract, physicians and hospitals are measured - and paid - for providing better quality care with better patient outcomes. It places more focus on preventive care, to keep people healthy and prevent expensive ER visits and hospitalizations.
In a fee-for-service model of reimbursing providers for health care, providers and health care organizations are reimbursed based on the volume of services provided instead of the outcome. Essentially, they are incentivized to "do" more. Ordering more tests, seeing more patients, and performing more procedures - regardless of medical necessity - results in higher costs. This model, while guaranteeing payment for all services delivered, is not always informed or driven by evidence of better health outcomes.
CHI Health Partners main goal is to move to value-based contracts with all insurance providers, and move away from the fee-for-service model.