During the last decade, value-based care models have gradually become more prevalent. A recent federal report found that healthcare payments associated with alternative payment models (APMs) reached 34% in 2017, an 11% increase from 2015.1 But embracing the shift from fee-for-service to value-based payment comes with many challenges, particularly when attempting to establish uniform operational processes to streamline implementation.
In 2005, the Council for Affordable Quality Healthcare (CAQH), a non-profit alliance of health plans and trade associations, established the Committee on Operating Rules for Information Exchange (CORE) to adopt and institute operating rules for administrative transactions in the U.S. healthcare industry. One of CAQH CORE’s primary functions was to standardize HIPAA electronic transactions. In 2012, this led to the HHS designating the organization as the authoring body for mandatory operating rules under the Affordable Care Act (ACA).