Payment for medical care in the United States is undergoing a seismic shift, from payment based on the volume of care provided to payment based on value. The emerging payment models change incentives and spread risk between health plans and providers. The intent is to create a delivery system that provides the highest quality care in the most efficient manner.
This project assesses the likely impact of these changes on rheumatology, a specialty that has not fared as well as other specialties under the traditional fee-for-service payment model, and which may benefit from emerging payment models that provide stronger incentives for care coordination and management of chronic conditions. Major project components include a literature review and key informant interviews with 11 rheumatologists in different health care markets across the country. The project will culminate in a white paper and a toolkit for rheumatology practices.