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The Historical Development of Value-Based Care: How We Got Here


The original architects of Medicare modeled the payment system on the existing fee-for-service (FFS) structure that historically dominated the health-insurance market. Under the FFS paradigm, health-care expenditures experienced an exponential rise. In response, the managed care and capitation models of health-care delivery were developed. However, changes in Medicare reimbursement, along with an increasing volume of orthopaedic procedures and escalating implant costs, call into question the cost-effectiveness of this service line. The success of the Medicare Acute Care Episode (ACE) Demonstration Project proved the feasibility of value-based care and ushered in a new era of bundled payment initiatives.

Novikov, David BS1; Cizmic, Zlatan MD1; Feng, James E. MD1; Iorio, Richard MD1; Meftah, Morteza MD1Author Information
The Journal of Bone and Joint Surgery: November 21, 2018 – Volume 100 – Issue 22 – p e144doi: 10.2106/JBJS.18.00571