• linkedin
  • Increase Font
  • Sharebar

    This is why value-based care is not going away this year

    Last year’s uncertainty over the future of value-based care did not deter Marlyce Hill Ali, MD, from delivering healthcare in the way she thinks is best.

    The internist at JenCare Senior Medical Center in Louisville, Kentucky, was aware of the questions about the new administration’s approach to value-based care, as well as turnover at the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS). But she never had doubts about the value-based care model.

    “We’re still operating with the status quo and still functioning the way we were founded to perform. It hasn’t affected operations at all,” she says.

    By the end of 2017, much of the uncertainty had lifted. The shift toward value-based care is continuing, though this year is likely to see some adjustments that could ease the regulatory burden on physicians.

    That’s good news to advocates like Ali. “I think everyone, regardless of political affiliation, likes the notion of value-based care, getting the most bang for your buck in healthcare,” she says.


    An uncertain 2017

    Last year was a tumultuous one for healthcare. For many physicians, 2017 was the first year of reporting quality measures under the Medicare Access and CHIP Reauthorization Act (MACRA). Meanwhile, the Trump
    administration and GOP-controlled Congress failed to overturn the Affordable Care Act and Tom Price was named HHS secretary, but later resigned under pressure.

    Some of the new administration’s moves, such as cutting bundled payment programs, prompted questions about its commitment to value-based care. 

    “When they proposed cutting back the mandatory bundled payment program, there was a fear that they were going to hit the brakes on payment reform on everything, and we haven’t seen that,” says
    Timothy Gronniger, MPH, former chief of staff at CMS and now senior vice president at the consulting firm Caravan Health. “Payment reform is so deeply entrenched across the industry right now that CMS doesn’t seem to want to stop that nor do they have an alternative vision for that.”

    Value-based care has maintained broad support, even in the highly partisan atmosphere in Washington, says Jeff Micklos, executive director of the Health Care Transformation Task Force, a consortium of patients, payers, providers and purchasers. Policymakers have largely exempted it from the debate over the ACA, he says.

    There is no appetite in Washington to revisit value-based care, agrees Shari Erickson, MPH, vice president of government
    affairs and medical practice at the American College of Physicians (ACP).   

    “The law was so recently passed and done in a bipartisan way that everyone thinks that it’s better to move forward,” she says.

    CMS Administrator Seema Verma, a former healthcare consultant who made her reputation advising states on how to restrict Medicaid eligibility and roll back the ACA, has indicated that she supports value-based care and wants the pilot programs to accelerate. “I think while we are moving in that direction, we’re probably not moving fast enough,” she said in a speech in the fall of 2017.


    A difficult journey

    While the administration assessed value-based care, physicians such as Lerla Joseph, MD, simply implemented it.

    The internist with Charles City Medical Group in Richmond, Virginia, formed an accountable care organization (ACO) in 2011, the Central Virginia Coalition of Healthcare Providers, because she thought value-based care was a better way to deliver care.

    She has since recruited 21 small practices with 53 practitioners in Virginia and North Carolina into the group. The ACO met the minimum patient threshold to qualify for the Medicare Advantage program in 2015 and is now in its second year reporting quality measures under MACRA.  

    “Everyone focuses on value-based care in the practice, from the front desk to me,” she says. “We can see the improvement in our patients and in our quality metrics.”

    The ACO hasn’t yet seen the savings they’ve hoped for, but Joseph is confident it will. In the meantime, the group continues to invest in population health management tools and training staff to work to the top of their licensing, such as having medical assistants assess patients and do appointment follow-ups.  

    “This is the direction everyone is moving, even with our commercial contracts,” she says. “It’s been a difficult journey, but I’m glad I persisted because it’s been good. I really do think ACOs are the best hope for the future of small, independent practices.”


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Latest Tweets Follow