The Evolution of Value Based Care: Key Insights

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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.

One of the positive things that has come out of the pandemic is that we have been laser-focused on the senior population. They had been slow to embrace telehealth, but I think COVID forced people to at least try it. It’s not a replacement for an in-person visit with your PCP, but when you’re tightly managing your chronically ill folks, it’s a useful tool. I also think that more aggressive care in the home is going to explode over the next 10 years. Meeting patients where they’re at to take good care of them is another big trend to come out of the pandemic. – Debra Finnel

5. The future of value-based care: What are the major obstacles providers need to overcome to achieve success in this new environment?

One of the challenges that we physicians have to take responsibility for is we don’t have enough physician leadership. To get the buy-in of the providers, we need leadership that’s mission driven. Payers have to step in, too. There aren’t many practices ready for value-based care, so when you find them, you have to support them, invest in them, raise them up so that they have the trust of their doctors. Doctors need to translate their data into a successful workflow, and Stellar Health does this so well by centering around behavioral economics…    You need that, and you need different ways of getting people to buy in.

– Richard Park

The culture change into embracing risk and shifting how you treat patients is significant and can’t be understated. It can be done, but it takes some handholding and a lot of transparency. Many people have been burned in the past; they have had bad experiences with risk. The word ‘capitation’ is not necessarily embraced so explaining the value and what it allows the practice to do is important… I’m happy that there is momentum in healthcare now, it’s allowing companies that want to bring value-based care to all communities the ability to do just that.

– Debra Finnel

In order for value-based contracting to work and to be successful there must be a partnership between the provider and the payer. It’s about meeting the provider where they need to be met. They’re your funnel, and if they’re successful, the payer will be successful. It’s about transparency, partnership, sharing your resources and making sure both parties are successful along with ensuring that the member’s health is optimized.

– Laura Breisch

The most encouraging thing as we were pulling this panel together, was that it was easy to get Laura, Deborah and Richard to engage with us. I think it’s probably been easier than it’s ever been before to get payers and providers to collaborate. And maybe that in itself is emblematic of where value-based care is headed in our country, which I’m encouraged by.

– Michael Meng