Since President-elect Trump’s victory on November 8th, many payers and providers are anxious that the entire healthcare landscape is shifting … and quickly. While we will almost certainly see some changes coming down the pipeline, including a full or partial repeal of the Affordable Care Act, we are confident that value-based payment reform models are not going anywhere. According to Blair Childs, Senior Vice President of Public Affairs at Advocacy Group Premier Inc., the Trump administration and republican Congress won’t put the brakes on value-based payment reforms “due to financial pressure to reduce spending, bipartisan support for the reforms, and the fact that these ideas originated with the Republicans.” Helen Darling, interim president and CEO of the Washington, D.C. based National Quality Forum, echoed this sentiment. “The concept of value in healthcare has been around a long time. Fundamental ideas like the importance of transparency and data to patients, providers, and competition existed well before the Affordable Care Act, and they are as Republican as they are Democratic.”
So what, exactly, are value-based programs? In a fee-for-service model, conditions are treated as they occur, requiring additional visits for each new symptom. On the other hand, “Value-based programs reward healthcare providers with incentive payments for the quality of care they give to people,” according to the Centers for Medicare & Medicaid Services (CMS). Value-based program shifts the paradigm from episodic care to whole-person care where providers are rewarded for keeping patients healthy. Two key factors that will almost certainly ensure the continuation of value-based programs are: MACRA legislation and the industry-wide emphasis on care coordination.
In recent years the growing prevalence of chronic disease, an aging population, and rising costs have strained the healthcare system. Many observers have blamed the reactive and episodic fee-for-service model for healthcare spending increases. Consequently, the Medicare Access & CHIP Reauthorization Act (MACRA) is designed to overhaul how physicians are paid under Medicare. In addition, it designates the use of health IT solutions to achieve value-based care. This bi-partisan law goes into effect January 1, 2017 with support from 91 percent of Congress. With the likely repeal of part or most of the ACA, MACRA will play a more important role in ensuring the continued efforts to achieve value-based payment reform. “MACRA creates the impetus for moving away from fee-for-service,” said François de Brantes, executive director of the Health Care Incentives Improvement Institute. If the ACA was the only legislation to foster alternative payment models, “that’d be cause for concern. But it isn’t.”
Another key player that will ensure the continued focus on value-based care is the industry-wide initiative to improve patient outcomes and reduce overall costs through whole-person care coordination. In order to achieve whole-person care coordination, doctors, hospitals, and community-based organizations must work together to coordinate care, particularly for super-utilizers who consume plenty of healthcare resources.
An integrated care coordination solution connects multiple providers and systems of care across a common platform and delivers custom patient care plans that are individually suited to the needs, circumstances, and abilities of each patient. It also provides a key data point that no other information system provides: data for the social determinants of health. All of these factors combine to help payers and providers achieve improved patient outcomes and reduced costs through whole person care coordination.
This should reassure everyone going forward. Regardless of the possible repeal of the ACA and any unknown decisions from the new administration, the focus on MACRA and care coordination ensure that value-based care is here to stay.