The Evolution of Value Based Care: Key Insights
In case you missed the live virtual discussion, The Evolution of Value Based Care, held on July 15, 2021 – here’s an opportunity to review some of the key insights
Hosted by NYC Health Business Leaders, the hour-long conversation was moderated by David Kopans, Of Counsel at Jones Day and included Laura Breisch, Vice President of Value Capture at Oscar Health; Debra Finnel, CEO of ilumed; Michael Meng, CEO of Stellar Health; and Dr. Richard Park, CEO of Rendr and Founder of CityMD.
We have seen the evolution of new value-based care models, including the introduction of bundled payments, shared savings programs, Medicare Advantage plans, and most recently, Direct Contracting Entities (DCE). There have also been changes to regulatory hurdles that should now help to pave the way for value-based payment initiatives, such as the Anti-Kickback Statute, the Stark Law, and HIPAA. Yet even with this progress, we still see far more fee-for-service payments than value-based payments. This panel discusses what obstacles remain for physicians to accept partial or full risk and how they should think about direct contracting relative to Medicare Advantage contracting.
Here are key insights from the wide-ranging discussion. You can also watch the video of the full discussion here.
1. Medicare and Medicare Advantage have remained largely fee-for-service. One of the goals of moving to value-based payment arrangements is to deliver more value at the practice level than fee-for-service arrangements have.
Value-based care (VBC) tends to be the most prominent in Medicare Advantage and traditional Medicare because there typically is a lot more spend to control. The Center for Medicare and Medicaid Services (CMS) has put greater emphasis on VBC in both programs through programs like the Medicare Shared Savings Program and Next Gen Accountable Care Organizations, as well as creating reward systems around quality, coding and total cost of care performance.
In my opinion, the advent of DCE or direct contracting entities… is to bring parity to all members of Medicare, whether they belong to traditional Medicare, DCE, or Medicare Advantage health plan. One really interesting trend we’ll see is that Medicare Advantage plans and DCEs become more comparable in terms of the reward systems, the capital earned, and the quality that they’re trying to direct for patients or members. – Michael Meng
2. Moving to a payment system that is focused more on the quality of services than the quantity of services is impacting how healthcare is being delivered.
We need to focus on the patients, getting the right care at the right time and the right place. Reducing unwanted or unnecessary care and shifting the provider and payors to focus on the quality of the care will keep members healthy by giving them the right treatment. It’s not only going to benefit the member, but it will also benefit the healthcare system in its entirety. – Laura Breisch
3. There is more competition between traditional payers and newer entrants into the market for a limited pool of lives. Individuals are influenced by many factors in selecting a health plan – and healthcare providers are playing a larger role in these enrollment decisions.
If providers create a model with great care, then people will flock to it, and you can make the economics work… I am a big believer in hyper segmentation and matching – almost like a bespoke model to the care. That’s why I think Chen Med, Oak Street and Iora are all great and have something to add… and Oscar! – Richard Park
4. The pandemic has had a huge impact on virtual healthcare and the quality of care. These changes are contributing in both positive and negative ways towards the effort for value-based care in healthcare.
