Through Medicare, Medicaid, the Children’s Health Insurance Program, TRICARE, the Indian Health Service, the VA Healthcare system and other programs, the government is the largest payer for health care in the country. Many health policies are implemented as incentives within the reimbursement system. Understanding these programs and how the incentives impact an industry are essential to effective government relations.

In recent years, federal health policy makers have sought to move away from a fee-for-service payment methodology that seemingly rewards providers for simply providing more care and instead, promote payment policies that reward providers for providing better care. In effect, institute a payment system that rewards value and the quality of outcomes. New payment models are being introduced and tested by the Center for Medicare and Medicaid Innovation and could if moved beyond the demonstration phase, dramatically change where, when and how health care services are provided.

Congress consolidated many of the new, innovative payment models into a single program called the Merit-based Incentive Payment System which financially rewards or penalizes healthcare providers based on their relative performance under four categories: Quality, Cost, Practice Improvement and Utilization of Information technology. Meanwhile, Congress and CMS continue to develop and implement new Alternative Payment Models. Understanding the complexities of these new quality-based reimbursement systems will, we believe, prove to be among the most significant challenges for health policy in the near future.

Our team has been intimately involved in virtually every major healthcare debate that has occurred over the past four decades, and have been front and center advising elected officials on how to vote on these policy changes or helping Corporate Executives and Association leaders understand the impact of these policy changes.

CAI staff bring decades of experience working with both Congress and the Agencies on reimbursement issues to effectively manage an association’s role in the reimbursement process and to make sure their priorities align with current and future trends.