Speeding the Transition to Value-based Care

During a recent Capitol Hill briefing, Representative Brad Wenstrup, former Centers for Medicare & Medicaid Services (CMS) Administrator Mark McClellan and a panel of population health experts and patients delved into how accountable care organizations (ACOs) and other value-based care models have enabled providers to completely transform their approach to care, resulting in better disease prevention, healthier patients, cost savings and more equitable care for communities at risk.

Recently, a group of 44 bipartisan lawmakers who recognize the need to preserve the current incentives for healthcare providers to adopt value-based care approaches sent a letter to House leadership urging Congress to extend the Advanced Alternative Payment Model (APM) incentive payments due to expire this year and make other important changes to expand these benefits to more Americans.

Rep. Brad Wenstrup (R-OH), a physician of more than 30 years and Member of the Congressional Doctor's Caucus, provided opening remarks underscoring the need to reward healthcare providers who are working to prevent people from needing medical interventions and taking measures to keep them healthy. A cosponsor of the Value in Health Care Act of 2021 (H.R. 4587), Wenstrup said an extension of Medicare’s Advanced Alternative Payment Model (APM) bonus is a common sense change essential to providing financial resources needed for care innovation and removing the red tape that inhibits providers from joining these models.

Susan Dentzer, President and CEO of America’s Physician Groups, articulated the importance of rewarding prevention and improved health outcomes, which are integral components of value-based care.

Former CMS Administrator Mark McClellan, M.D., explained how many of these reforms are succeeding in lowering costs and providing better patient centered care, including the Medicare’s largest value-based payment program, the Medicare Shared Savings Program (MSSP). The Medicare Advanced Alternative Payment Model (APM) payment bonus has helped organizations in value-based care models expand services beyond traditional fee-for-service, such as funding wellness programs, reducing cost sharing for beneficiaries and improving patient care coordination.

Dr. Robert Fields, Chief Population Health Officer of Mount Sinai Health System in NYC, described the failures of the fee-for-service payment system in supporting the care that people need the most, particularly for disenfranchised, older and chronically ill patients. Caring for these patients is complicated, and it is only though value-based care that he and his care team can provide closer to equitable outcomes while saving taxpayer dollars. The Medicare APM bonus payment is critical to support these efforts.

Dr. Jon Regis, Business Development Executive for Village Medical in New Jersey, who serves a large volume of Medicaid and chronically-ill patients said that value-based care allowed him to keep his doors open during the pandemic, including by employing a care team, boosting primary care and providing services via telehealth. Dr. Regis calls it a “game changer” to be able to reach an historically underserved population and provide proactive and preventive care.

Dr. Richard Shuman, CEO of Baycare Health Partners in western Massachusetts, summed up value-based care by describing how it comes down to caring for the entire population within his patient community, not just the patients in front of him. Unlike the fee-for-service payment system, value-based care is an opportunity to be proactive as opposed to reactive.

Dr. McClellan talks about the importance of Congress extending the Advanced Alternative Payment Model bonus.

Dr. Kisha Davis, Vice President of Health Equity, Aledade, Inc., talked about the flexibilities value-based care provides to address the social drivers of health that might be getting in the way of patients achieving optimal health. By tying provider payments to both quality outcomes and financial savings goals, patients benefit. The savings from value-based care models provide critical resources to reinvest in the community.

Value-based care gives healthcare providers flexibilities not supported by fee-for-service to employ a team-based approach to care. This allows providers to address not only their patients’ medical needs, but also their social needs through engagement with social workers, physical therapists, home care dimensions and more. Hear from Gary, a patient with complex medical needs, and how his physician care team coordinates this full continuum of care and the real difference it has made in his life.

Congress can support a continued emphasis on movement to value by passing the Value in Health Care Act of 2021 (H.R. 4587).

Reach out to John Knapp at john_knapp@premierinc.com for more information.

Watch the full briefing here: