Alliance calls on Congress to advance value-based care
Innovative health care models took center stage before the House of Representatives as an advocacy organization presented its case for shifting away from fee-based medical care as a way to improve health care and lower costs.
Innovative health care models took center stage before Congress in late April as alternatives to the fee-based patient care system continued their national campaign to change the way U.S. health care is delivered – and paid for.
The Alliance for Value-Based Patient Care – a coalition advocating on behalf of the 630,000 physicians and other clinicians who participate in value-based models – presented its case for shifting away from fee-based medical care to the House of Representatives. The audience: staff and members of the House of Representatives. The host: the House Health Care Innovation Caucus. The specific purpose: to educate congressional staff on how value-based care works to benefit patients, the health care system, those who practice medicine, and those who pay for it.
Armed with testimony from value-based practitioners, the group walked audience members through the key distinctions between fee- and value-based models. In an introduction, presenters agreed that previous Congresses had made important strides to give more consumers access to value-based services. Now it was time for the elected officials to push for further support.
Value-based care is, in many ways, an ideal solution for employer sponsored health plans. An integrated medical team – including therapists and social workers – providing services for a defined group can focus wrap-around care on the employee population and gauge its impact annually on the group’s health. Because health outcomes determine the success or failure of the value-based provider, health maintenance and early detection are key to the provider’s financial model.
Related: Implementing value-based health care: Key trends shaping 2023
“Traditionally, doctors, hospitals and other providers are reimbursed for each individual service rendered – a system commonly referred to as fee-for-service,” the organization said in a prepared statement, “In recent years, innovative providers and policymakers have increasingly recognized the need to transition to alternative systems that reward accountability and create incentives for providing care in a coordinated manner focused around placing people at the center of their care, and keeping them healthy, rather than just treating them when they get sick.”
In that model, provider reimbursement and patient outcome are aligned, the group said.
“Alternative payment models (APMs) under value-based care encourage keeping patients healthy and out of the hospital, decrease unnecessary care, and lower costs for both patients and taxpayers.”
In testimony from individual practitioners, case studies and outcomes data were shared to underscore the efficacy of the value-based model. Primary care is emphasized in these provider groups, as are the social determinants of health.
In testimony, Dr. Ashish Parikh, Chief Quality Officer, Village MD, described the importance of learning whether patients were depressed; whether they had adequate transportation for health care appointments; whether they were financially stressed; and what their diet consisted of.
“We have a care management team that screens patients for social determinants of health. So, when I see a patient and see they have transportation issues, I can immediately connect them with a social worker in our group who can help them with the resources they need,” Parikh said.
What can the 118th Congress do to further support the uptake of the value-based model? Among the recommendations:
- Extend payment incentives for providers entering value-based care models, and ensure that the thresholds for qualifying for these incentives are reasonably attainable.
- Eliminate regulatory burdens for clinicians and improve financial methodologies, two major barriers for providers that want to offer value-based care.
- Simplify the Center for Medicare and Medicaid Innovation (CMMI) evaluation process.
- Create parity of requirements and program flexibilities between alternative payment models and Medicare Advantage.
“Value-based care is a simple idea but can quickly turn into complex policy. Hence, congressional briefings are important ways to help educate policymakers and their staff. During the April briefing, clinicians and other population health experts spoke about concrete ways their organizations’ work in value-based care has improved patient care,” AVBPC said.