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.