RevCycle Intelligence: Who is Leading the Value-Based Care Transition in Primary Care? (10/26) – Most primary care physicians are engaging with value-based care, with 69 percent participating in some type of APM. But a new report from Chartis Group has identified the primary care physicians leading this transition away from fee-for-service (FFS). While primary care physicians are moving in the direction of value-based care, they also identified major opportunities. First, an accompanying report finds some misalignment between which specialists primary care physicians have strong relationships with and those who are most impactful to value-based care. Second, primary care physicians need practice capabilities to deliver against value-based care. Third, primary care physicians who are more engaged with value-based care tend to use more advanced practice practitioners.
Healthcare Dive: The American healthcare system is broken — here’s what we can do to fix it (10/26) – Primary care continues to be deeply undervalued — accounting for just 5 percent to 7 percent of total health care spending in the U.S. Meanwhile, primary care physicians are experiencing burnout at record rates in a system that rewards volume of services over quality of care. As a primary care physician practicing for 26 years, I have witnessed firsthand how a value-based model of care can enable and empower physicians to deliver better care. Every stakeholder in the American health care system benefits when primary care physicians are empowered to manage the needs of their senior patients. Let’s make it a reality by prioritizing value-based care.
Health Affairs: Multi-Year Medicare Physician Fee Freeze Threatens Access: Pair Relief With Reforms (10/25) – A key element for long-term reform is revamping the Medicare physician fee schedule by replacing the dysfunctional process used to update the relative value scale over the last 30 years. A second important reform element is accelerating the shift away from FFS towards population- and episode-based payment. At a minimum, meaningful payment reform should include changing the process for setting relative values, enhancing the shift from FFS to population health, and linking physician fees to an appropriate input price index. Indeed, given that access problems are more of a concern for visit-dependent specialties, reform of the fee schedule to reduce bias against these specialties could lessen the magnitude of relief needed to reduce the risks to access from declines in inflation-adjusted fees.
Forbes: Why We Need To Invest In The Right Type Of Healthcare Innovation (10/25) – Consider the monumental impact in care experience, outcomes and cost we could create by investing more focus and resources toward changing primary care from its traditional, volume-based, FFS structure and moving it to a value-based prospective payment structure. First, we’d shore up stability among current public care providers. The second big change we could see from a greater focus on and investment in primary care is innovation in how care is delivered, as well as what results we might expect. By aligning outcomes to economics and then expanding how primary care providers view and use care teams, we can remove burdens and fulfill the promise of what primary care was always intended to be, for patients and primary care providers alike.
Milbank Memorial Fund: Saving Money or Improving Health? Reconsidering Payment Reform (10/25) – As CMS implements a strategic refresh of its value-based portfolio, the agency should consider pairing cost containment efforts with those that place population health first. CMS could launch new prevention-based demonstrations in Medicare. Moreover, lawmakers should amend the criteria for demonstration model certification to enable the expansion of models that are clinically superior but cost-neutral. Lastly, to minimize the implementation burden, CMS should deploy new prevention-based demonstrations under capitated arrangements. Payment reform is not a goal unto itself, but rather a means to move the delivery system toward higher value. By reorienting the design and interpretation of payment models toward health over savings, policymakers can reaffirm what is arguably the true bottom line: population health.
Inside Indiana Business: Lawmakers hear testimony on hospital, pharmacy concentration (10/21) – Health economic researchers from the University of California, Berkeley on Thursday shared their analysis of Indiana’s healthcare markets — determining that the concentration of insurers and hospitals has contributed to higher costs over the last decade. Prices at non-merged hospitals, for instance, remained relatively flat over the time period they analyzed, while those entities that had been involved in a merger or acquisition had prices increase by roughly 50 percent.
BMC Health Services Research: Five years’ experience with value-based quality improvement teams: the key factors to a successful implementation in hospital care (10/20) – Overall, this study goes beyond the general value-based care theory and provides health care providers with more detailed knowledge on how to practically implement value-based quality improvement in a hospital care setting. Factors in the ‘organization’ and ‘practice’ domain were mentioned in the strategic value agenda of Porter and Lee. Though, this study provides more practical insight in these two domains. Factors in the ‘culture’ domain were not mentioned in the strategic value agenda and have not yet been thoroughly researched before.
World Economic Forum: Value-based healthcare payments are the future. Here's how to move from taxi to take-off (10/20) – Despite a decade of experiments in value-based payments, we have yet to transform global health care systems. Value-based health care means focusing on delivering health outcomes that truly matter to the individual and society at large in cost-effective ways. The focus is on putting the individual at the centre of health and care. The pandemic spurred further interest in value-based health care after proving that it is no longer a leap of faith but indeed a must-have for sustainable and flexible health care systems. Health care transformation cannot happen in silos. It requires all stakeholders to engage and commit to a change that refocuses health care on value for patients.
Health Affairs: Performance Results Of The Medicare Shared Savings Program In 2021: Continued Uncertainty With Positive Movement (10/20) – Overall, this year’s results confirmed last year’s in that value-based payment models continue to be useful, particularly during a public health emergency. The accountable care organization (ACO) model offered providers greater revenue flexibility during COVID-19, potentially allowing them to quickly adapt their care delivery and build up critical capabilities to cope with the pandemic better than other providers. With a decade of experience in the Medicare Shared Savings Program (MSSP) model, we continue to see positive movement among ACOs in improving overall quality and reducing costs, as well as promising signs in improving equity, especially for people served by the safety net. Given the decline in participation, it is important that MSSP opportunities continue to be expanded and reach patients who would benefit from the accountability, care coordination, and patient-centered tools that value-based payment provides.
Health Affairs: Payment Policy And The Challenges Of Medicare And Medicaid Integration For Dual-Eligible Beneficiaries (10/20) – Establishing value-based payments in Medicare as a cost-savings strategy, where risk-adjusted payments are tied to better efficiency and better outcomes, is difficult when providers who treat dual-eligible beneficiaries already start off with lower payment rates because of Medicaid’s limited coverage of Medicare cost sharing. The lack of alignment between Medicare and Medicaid benefits manifests in the contradiction of paying plans and value-based payment organizations more on a per person basis to cover dual-eligible beneficiaries, but paying providers less on a per service basis to treat dual-eligible beneficiaries. When designing strategies that “adjust” quality incentives for dual-eligible status, policy makers should consider the full range of Medicare and Medicaid payment rules that affect coverage for dual-eligible beneficiaries to avoid perpetuating health inequities.
Harvard Business Review: How Health Systems Can Improve Relationships with Their Doctors (10/19) – Misalignment between physicians and health systems is among the fundamental issues ailing U.S. health care. One major cause is the tension between the goals of improving clinical quality and controlling financial costs, including aligning physicians’ compensation with value-based payment models. Health systems’ performance — and resiliency — depends on having aligned, collaborative relationships with physicians. These kinds of relationships take time to establish, and they must be built on trust, honesty, and transparency. But once those relationships are in place, clinical care improves, and innovative care-delivery models emerge. Gains accrue in quality, productivity, and efficiency, which all contribute to better financial performance.
RevCycle Intelligence: NAACOS Calls on CMS to Adjust Digital Quality Measurement Requirements (10/19) – Before implementing program-wide requirements for digital quality measurement in the MSSP, CMS should establish a pilot that tests the technical feasibility and the impact on accountable care organizations (ACOs), according to the National Association of ACOs (NAACOS). Starting in 2025, MSSP ACOs must use electronic clinical quality measures (eCQMs) and digital quality measures (dQMs) for quality reporting. However, this may pose a challenge for ACOs as they can include multiple doctor’s offices, hospitals, and practices that do not use the same EHR system. The NAACOS Digital Quality Measurement Task Force issued a position paper calling on CMS to consider several recommendations before establishing eCQMs within the MSSP.
Fierce Healthcare: CMMI's Liz Fowler says financial stress delaying value-based care investments (10/19) – Providers that participated in value-based care generally fared better financially during the worst parts of the COVID-19 pandemic when non-essential procedures were largely on pause. But while regulators hoped that the pandemic may spur more investment in value-based care, that is not the case so far, said Center for Medicare and Medicaid Innovation Director Liz Fowler.“ Coming out of the pandemic, everyone we talk to say there are still pressures in the system around the workforce,” Fowler said during an event in Washington Wednesday held by the Better Medicare Alliance. Fowler said that providers that invested in value-based care were “more resilient and better able to withstand the precipitous drop in volume.” Fowler said that these pressures could be influencing provider interest in moving to a value-based care program or model. “We had hoped the pandemic might spur more investment in value-based care, but I think we need to be realistic about what providers are able to do,” she said.