The Alliance for Value-Based Patient Care partnered with the House Health Care Innovation Caucus to host a briefing to educate congressional staff on how value-based care benefits patients, strengthens the health care system, increases flexibility for clinicians and lowers costs.
This education is critical as lawmakers begin to consider how to reform provider payment and incentivize participation in alternative payment models (APMs).
Congress can support clinicians by extending APM incentives, improving financial methodologies for accountable care organizations (ACOs), establishing a full risk track in the Medicare Shared Savings Program (MSSP) and considering parity between APMs and Medicare Advantage.
For more than a decade, value-based care has sustained bipartisan support within Congress and across multiple administrations. This past year was no exception, with Congress passing an extension of important incentives for health care providers to participate in value-based care models. Efforts are underway in the 118th Congress to build on this progress, with the support of the House Health Care Innovation Caucus. To this end, the Alliance for Value-Based Patient Care partnered with the House Health Care Innovation Caucus and other stakeholders to educate lawmakers on the importance of value-based care, hosting a briefing in late April for congressional staff. The recording and slides from the briefing are available online.
Traditionally, doctors, hospitals and other providers are reimbursed for each individual service rendered – a system commonly referred to as fee-for-service. In recent years, innovative providers and policymakers have increasingly recognized the need to transition to alternative systems that reward accountability and create incentives for providing care in a coordinated manner focused around placing people at the center of their care, and keeping them healthy, rather than just treating them when they get sick.
Enter value-based care, which aligns reimbursement for providers with accountability for delivering outcome-based, high-quality care that is more efficient and bends the cost curve. Alternative payment models (APMs) under value-based care encourage
keeping patients healthy and out of the hospital, decrease unnecessary care, and lower costs for both patients and taxpayers. An example of value-based care is the accountable care organization (ACO), which gives providers the flexibility to innovate care and holds them accountable for the clinical outcomes and cost of treating an entire population of patients.
Value-based care is a simple idea but can quickly turn into complex policy. Hence, congressional briefings are important ways to help educate policymakers and their staff. During the April briefing, clinicians and other population health experts spoke about concrete ways their organizations’ work in value-based care has improved patient care.
Chris Elfner, Vice President, Bellin Health
Chris Elfner described how value-based care aims to prevent disease and avoidable hospital stays. For example, in 2016, when Bellin Health joined the Next Generation ACO Model, only 42 percent of their patients had an annual wellness visit. By 2021, 80 percent of their patients had a wellness visit, allowing doctors to focus on preventive screenings and disease management. “We were able to figure out how to catch things like a pre-cancerous polyp before it becomes symptomatic and becomes something terrible,” Elfner said.
Dr. Christine Meyer, Founder CMMD & Associates
Participating in an ACO has provided Dr. Christine Meyer’s practice the financial resources to invest in a strategy that helps avoid costly emergency care. Dr. Meyer provides more than 200 of her medically complex, highest-cost patients with a phone number that connects them directly to a primary care provider or care manager. It is estimated that this hotline has been used hundreds of times to get patients the level of care they need when they need it, avoiding countless emergency department and specialist visits, as well as unnecessary spending. “Saving the ED dollars, connecting with our patients on a deeper level, none of that would be possible without the ability to pay for that phone, pay for my team to answer that phone. That would not have been possible without these (value-based) contracts,” Meyer said.
Dr. Ashish Parikh, Chief Quality Officer, Village MD
In the absence of value-based care or outcomes-based payment, providers are not afforded time to ask patients about issues that may limit their ability to access care, including transportation challenges, the state of their mental health or their ability to pay for prescription medications. Under value-based payment, providers are rewarded for better outcomes and can reinvest payments into infrastructure to support their entire population with whole-person care because they are incentivized to understand all factors contributing to their patients’ well-being. Dr. Ashish Parikh described a patient he recently saw who was screened for social determinants of health prior to their appointment. “Now, we have a care management team that screens patients for social determinants of health. So, when I see a patient and see they have transportation issues, I can immediately connect them with a social worker in our group who can help them with the resources they need,” Parikh said.
How can Congress support this transformation?
Twelve leading health care organizations have developed recommendations to promote value-based patient care in Medicare. These recommendations have been shared with Congressional leaders and include:
Extending payment incentives for providers entering value-based care models and ensuring that the thresholds for qualifying for these incentives remain attainable for new and already participating clinicians.
Removing barriers to participation in value-based care models, including eliminating regulatory burdens for clinicians and improving financial methodologies.
Establishing more predictability and stakeholder involvement in Center for Medicare and Medicaid Innovation (CMMI) evaluation (including focus on equity and provider types).
Considering parity of requirements and program flexibilities between APMs and Medicare Advantage.
The Alliance for Value-Based Patient Care is working with partners, including NAACOS, Premier Inc. and congressional champions, to include these recommendations in an updated version of the Value in Health Care Act in the 118th Congress.
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Seth Edwards, MHA
Vice President, Population Health, and Value-based Care, Premier
Seth has expertise in healthcare policy and strategy implementation. Leveraging this expertise, he guides healthcare providers in building effective value-based care/payment, shared savings and alternative payment model capabilities. @SethEdwardsMHA
Aisha Pittman, MPH
Senior Vice President, Government Affairs, National Association of ACOs
In her role, Aisha Pittman leads NAACOS’ work to promote legislative and regulatory policies that will advance ACOs.