Multiple Chronic Conditions Blog

Reimbursed for Value vs Volume – are you using the Evidence?

Saturday, 28 February 2015 14:34 / by Dr Kim Kuebler

U.S. Department of Health and Human Services (HHS), Secretary Burwell, announced in late January, explicit details on how the American health-care system will transition from fee-for-service reimbursement to alternative payment models as a critical step toward:


This is the first time in the history of the US health care system to move from payment for volume to payment for value. Value is identified through quality measures – currently under review through the National Quality Forum. Value, that comes through the use and implementation of current evidence and use of clinical practice guidelines.

HHS’s Advanced Payment Reform plans to modify 30% of fee-for-service claims by the end of 2016 by employing alternative payment models: Accountable Care Organizations (ACOs), primary care medical homes and bundled payments, like this year’s chronic care reimbursement model – planned for over 50% of value based reimbursement by 2018.

HHS will use the current Hospital Based Purchasing and Hospital Readmissions Reductions Programs, to transition by 85% for all Medicare reimbursement in 2016 and up to 90% by 2018.


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Dr Kim Kuebler

Dr Kim Kuebler

Dr. Kim Kuebler DNP, APRN, ANP-BC, FAAN, Founder and Director Multiple Chronic Conditions Resource Center, CEO Advanced Disease Concepts, LLC., Award winning author of 8 textbooks on chronic conditions and palliative care. Multiple appointments to Federal and state initiatives on pain, chronic conditions and palliative care. Clinician, educator, researcher and patient advocate.