The Leap to New Payment Models

Washington Rheumatology Making Data Actionable


Faced with mounting regulations and declining reimbursements, many rheumatologists are recognizing that accountability and standards will inform payers and patients on how treatment decisions correlate to cost and quality.

New legislation proposes to dramatically shift how physicians are reimbursed. The shift from fee-for-service care to a value-based paradigm will be supported by health information technology capable of collecting electronic data from robust population health record systems. New alternative payment models will use a population health management platform to help to define a population, identify gaps in care, stratify risks, engage patients, manage care and measure outcomes. Quality metrics will need to be incorporated into a new hybrid form of value-based contracting that reflects appropriate treatment decisions, cost-effective care, while improving patient engagement, employer engagement, coordination of care, and patient adherence to medication and treatment plans.