From Fee-for-Service to Value-Based Care: The Evolution of Healthcare Payment Models

In this episode, we dive deep into the fascinating journey of healthcare payment models and how they're transforming to enhance patient care, reduce costs, and improve the well-being of healthcare providers.

What You'll Learn:

The Traditional Fee-for-Service Model: Understand how paying for each individual service led to a focus on quantity over quality.

The Rise of HMOs in the 1970s: Explore how Health Maintenance Organizations aimed to control costs and emphasize preventive care.

Introduction of DRGs in the 1980s: Discover how Diagnosis-Related Groups incentivized hospitals to improve efficiency.

Standardizing Physician Payments in the 1990s: Learn about the Resource-Based Relative Value Scale (RBRVS) and its impact on fair compensation.

Pilot Programs of the Early 2000s: See how initial experiments set the stage for significant reforms.

Transformations from the Affordable Care Act: Delve into Accountable Care Organizations (ACOs) and Bundled Payments that shifted the focus to value-based care.

The Leap with MACRA in 2015: Understand how the Medicare Access and CHIP Reauthorization Act pushed providers toward quality improvements.

The APM Framework's Four Categories: Get to know the roadmap guiding the shift from volume to value.

The Quadruple Aim of Healthcare: Grasp how improving patient experience, population health, reducing costs, and enhancing provider well-being are interconnected.

Marginal Utility in Health Economics: Learn why more services don't always mean better outcomes.

Why This Matters:

The evolution from Fee-for-Service to Alternative Payment Models reflects a significant shift toward value-based care. This journey impacts everyone—patients, providers, insurers—and aims to achieve the Quadruple Aim of better outcomes, better experiences, lower costs, and improved provider well-being.

• 00:00 - Introduction

• 00:36 - Fee-for-Service Model Refresher

• 01:07 - Health Maintenance Organizations (HMOs) in the 1970s

• 02:43 - Diagnosis-Related Groups (DRGs) in the 1980s

• 04:21 - Resource-Based Relative Value Scale (RBRVS) in the 1990s

• 06:12 - Medicare Modernization Act and Pilot Programs in the 2000s

• 07:35 - Affordable Care Act (ACA) in 2010 and Accountable Care Organizations (ACOs)

• 09:00 - Bundled Payments

• 10:55 - Medicare Access and CHIP Reauthorization Act (MACRA) in 2015

• 12:10 - Conclusion

Roupen Odabashian:

LinkedIn: https://www.linkedin.com/in/roupen-odabashian-183aaa142/

X: https://twitter.com/RoupenMD

Email: roupen@deltahealth.tech

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