As Congress and the Trump Administration move full-steam ahead on a new health policy agenda, there’s relief in knowing that not every aspect of healthcare is a politically contentious issue.
Take the movement toward value-based care. New delivery models that incent providers to clinically integrate and assume accountability for delivering the best outcomes for their patient populations has broad support. It is likely to accelerate in the years ahead – with full backing from both sides of the aisle.
- MACRA, which moves physicians into the world of alternative payment and value-base care, was passed by a Republican-controlled Congress with overwhelming bipartisan support and signed by President Obama. Meaning that both Republicans and Democrats have a vested interest in seeing value-based, pay-for-performance payments succeed.
- Significant investments have been made in these models already, and they are starting to bear the predicted fruit. There are now well north of 800 private and public accountable care organizations (ACOs) nationwide, and about 30 percent of all Medicare and Medicaid provider reimbursements are flowing through an alternative payment model. Just in the Medicare program, which includes more than half of all ACOs, participants have generated $1.29 billion in Medicare savings since 2012, while improving quality. Premier’s experience with our ACO collaborative has been even better, making up just six percent of ACOs in the program, yet generating 20 percent of the savings.
- Value-based care and alternative payments are the only anecdotes to perpetual cuts to fee-for service (which we can most definitely expect), as well as rising costs for medical devices and drugs. In today’s environment, discounts and price concessions are simply not enough to make the expense math work – the only solution is to improve population health to avoid unjustified utilization entirely. And the only way to earn revenues for that preventive work is through alternative payment.
While we know these models are working, there’s still room for improvement. Today, Premier, along with leading organizations representing clinicians, employers, labor, hospitals, pharmacists, consumer groups and insurance carriers across the country, released policy principles that should be addressed to ensure that the movement toward value-based care continues and that models are fixed to attract additional providers.
As a core principle, we must empower and engage patients to make healthcare decisions with information and support from their healthcare team.
There are hundreds of different measures included in overlapping value-based care models. As we move forward, we need a common set of measures used across all public and private programs, and they need to assess performance in a way that is meaningful and actionable by consumers.
While provider access to beneficiary data is improving, we should revisit this issue to ensure that information is more complete, timely and accurate to better facilitate care management and proactive provider interventions.
More models are being developed all the time, but we need a concerted effort in evidence-based testing of new alternative payment models so that providers, payers and patients can learn how they work in the real-world and how they should evolve in future clinical settings. It’s also imperative to test the incentive structure so that we know what works and what doesn’t in terms of the ROI, and how those incentives affect patient care.
Participants in alternative payment do have the ability to qualify for legal waivers that can stand in the way of collaboration and shared accountability, but while programs are being retooled, Congress should take a look at expanding these to all ACOs, not just those participating in Medicare programs. We should also allow additional waivers for participants to offer beneficiary engagement tools such as co-pay waivers or transportation vouchers.
We stand prepared to work vigorously with the Administration and Congress to expand upon the quality and cost savings progress made in America, and we look forward to taking the next steps to reach and surpass the tipping point where value-based healthcare becomes a sustainable marketplace for generations of Americans to come.
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