Where Value-Based Purchasing is Still Nascent

Philip Betbeze, June 20, 2014

A recent conversation with a hospital president in Nebraska shows that it's not always payers who are forcing the value-based conversation.

Michael Schneiders

Michael Schnieders
President, Good Samaritan Hospital

Hospital and health system leaders have been abuzz about the dramatic shifts their organizations face in moving away from fee-for-service reimbursement. That means, in most cases, that the Centers for Medicare & Medicaid Services and commercial payers are forcing hospitals, physicians and health systems to begin to take risk based on quality, cost, and outcomes.

But it's largely a regional story. One health system in Texas or California might be neck deep in negotiations with commercial payers while another in Nebraska feels like its dominant health plan hasn't yet heard the news.

CMS value-based payment initiatives are, of course, available nationwide, but this is a transformation that seems to need commercial backing to reach the tipping point. As a result, if the commercial payers aren't pushing it in a certain region, this 180-degree shift in the hospital and health system business model is still in its infancy.

That doesn't mean hospital and health system administrators don't know what's coming. In fact, in some areas, hospitals and health systems seem more willing to integrate risk-based reimbursement than are payers.

Such is the case in Kearney, NE. I spoke recently with Michael Schnieders, president of Good Samaritan Hospital there in connection with my cover story in the June issue of HealthLeaders magazine, which explores what's going on with value-based reimbursement in more mature markets.

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.


Facebook icon
LinkedIn icon
Twitter icon