What do you need to know about value based care for your practice?
by Michael Jones
The Centers for Medicare & Medicaid Services have advanced value based care significantly in the last several years, and in a somewhat expected, yet bold move in October 2021, specifically said that they expect all traditional Medicare beneficiaries to be treated by a provider in a value-based care model by 2030. CMS rarely uses such superlative terms (all traditional Medicare beneficiaries), and the Centers for Medicare & Medicaid Services Innovation Center (CMMI) has five stated strategic objectives to achieve this massive undertaking.
Those five pillars are (Value Based Care News) :
Drive accountable care
Advance health equity
Support innovation
Address affordability
Partner to achieve system transformation
Advancing health equity is at the heart of much of these new innovations. “As the first African American woman to lead CMS, I wanted to make sure that our programs are operating through these health disparities that underlie our healthcare system, which were especially illuminated by the COVID-19 pandemic,” CMS Administrator Chiquita Brooks-LaSure said in a listening session yesterday.
“President Biden has made it clear that we’re going to address racial equity using a whole-of-government approach,” Brooks-LaSure continued. “As CMS, how are we promoting health equity will always be the first question we ask. Nevertheless, we are doing everything we can to break down barriers to care and lift up underserved communities.”
Dr. Liz Fowler, Deputy Administrator and DIrector of CMMI further shares her vision of increased engagement across payers in this statement. “We need to align our priorities and policies across CMS and work in tandem with commercial payers, purchasers, and beneficiaries to achieve our vision by 2030,” Fowler explained. “We’d like all of our new models to incorporate multi-payer alignment, however possible.”
Finally, advancing on the spectrum of risk is an important consideration addressed by CMMI, with providers being able to access more timely tools and data to facilitate taking on risk with payers. CMMI has declared an intent to assess more population-based and advance payment models, with a focus on per member per month (PMPM) payments to encourage greater participation in value based care models.
What does all of this mean for physician practices, administrators, and physicians, though?
As the adoption of value based care models has grown, data has become more readily available to CMS and CMMI. Health outcomes are improving, overall costs are decreasing, and awareness of how to participate in value based care continues to grow. As this awareness grows, much of the positive can be validated, but there are also still significant opportunities to continue to advance the structure of value based care programs.
Striving toward health equity and a healthcare delivery system that gives patients access to high quality, appropriate care is a goal that is within reach. With more adoption of value based care models and more collaboration across payers, with data and information flowing more readily, we are on the way toward a much deeper value based care system.
Physicians and practices who embrace this wave, becoming part of the process, will be positioned to not only be rewarded financially, but will be part of a strongly favorable shift in the healthcare system as a whole.
This week’s article is intended to be an introduction to value based care, with a reference toward current developments. In future weeks, we will explore many concepts and value based care models in much greater depth.
