New reimbursement models challenge providers and create opportunities

Significant changes in reimbursement policy are on the way for providers of healthcare services in the US. These changes will alter the healthcare landscape, forcing providers to integrate information and care delivery in new ways and pushing onto center stage the quiet revolution occurring in quality improvement and system development. However, this transformation has inherent risks. How these changes are adopted will determine the success of efforts to improve care and reduce costs throughout the healthcare marketplace. Change is clearly on the way. During the past five years, the Centers for Medicare & Medicaid Services has transformed from a passive payer of services, simply paying the bills when people get sick, to an active purchaser of high-quality, efficient care. Several models exist for using reimbursement policies to improve performance. Two very different philosophies used by healthcare policymakers are the tournament model and the improvement and attainment model. Reimbursement changes will be a challenge for many if not most providers.