A Guide to Understanding Reimbursement and Value-Based Care in the Military Health System.

Area of Science:

• Health Services Research
• Healthcare Management
• Military Medicine

Background:

• Rising U.S. healthcare costs drive demand for value-based care.
• Value is defined as health outcomes achieved per dollar spent.
• Limited research exists on value-based care within the Military Health System (MHS).

Purpose of the Study:

• To guide MHS physicians and providers in understanding current reimbursement and value-based care.
• To discuss strategies for enhancing value and military readiness.
• To use musculoskeletal care as a case study for improvement.

Main Methods:

• Outlined current value-based care methodologies in the MHS.
• Utilized musculoskeletal care as an example for strategic improvement.
• Reviewed existing MHS systems for measurement and reporting.

Main Results:

• The MHS has adopted value-based care strategies, primarily incentivizing process compliance.
• Initial steps in health outcome measurement and reporting are underway using systems like IRIS, NSQIP, and JOES.
• Current systems show progress but require further development for comprehensive outcome tracking.

Conclusions:

• Universal health outcome reporting and integrated practice units can accelerate MHS value-based care.
• Focusing on outcomes across the entire care cycle is crucial.
• Systematic outcome measurement and improvement bolster military medical readiness and warfighter effectiveness.