There seems to be broad support for shifting from reliance on volume-based provider payments to value-based payments. The term value-based payment connotes assessment of performance and making payments commensurate with that assessment. However, most of the actual payment models specified in the Affordable Care Act for testing actually are not based on performance assessments but rather primarily alter payment incentives, with the goal of rewarding value whether or not the enhanced value can be directly recognized and rewarded. This paper explores the challenges in trying to move payment from "volume" to "value" and supports the focus on altered incentives, rather than assessments of performance.
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