The document outlines various models for transitioning from fee-for-service to value-based care, including pay for performance, bundled payments, patient-centered medical homes, accountable care organizations, and value-based Medicare Advantage plans, with each model transferring more financial risk from fee-for-service reimbursement to coordinated, quality-based care.

1. proprietary + confidential
Transition to Value-based Care
Fee For
Service
Pay For
Performance
Bundled
Payments
Patient-
Centered
Medical Home
• Traditional
Reimbursement
methods
• Payments for
services
rendered
• Hospital Value-
based
Purchasing
Program (HVBP)
• Hospital
Readmissions
Reduction
Program
(HRRP)
• Hospital-
Acquired
Condition
Reduction
Program
(HACRP)
• MACRA
• Care delivery
model whereby
patient treatment
is coordinated
through their
primary care
physician to
ensure they
receive the
necessary care
when and where
they need it, in a
manner they can
understand
• Reimbursement
on the basis of
expected costs
for clinically-
defined episodes
of care
Fee-for-
service
Performance-based Incentives Transfer of Risk
Medicare
Advantage
Value-Based
Model
Accountable
Care
Organizations
• Groups of
doctors,
hospitals, and
other health care
providers, who
come together
voluntarily to
give coordinated
high quality care
to the patients
they serve
• Opportunity for
Medicare
Advantage plans
to offer
supplemental
benefits or
reduced cost
sharing to
enrollees with
CMS-specified
chronic
conditions