Value-based pay­ment will con­tinue, but who will lead the way?

Modern Healthcare - - NEWS - —El­iz­a­beth Whit­man

Value-based pay­ment is likely to sur­vive un­der the Trump ad­min­is­tra­tion, though who leads these ini­tia­tives and how they are struc­tured may change.

“Health­care sys­tems will still want to think about that tran­si­tion from vol­ume to value,” said Derek Fee­ley, CEO of the In­sti­tute for Health­care Im­prove­ment.

What’s less clear is who will take on de­vel­op­ing, test­ing and im­ple­ment­ing al­ter­na­tive pay­ment mod­els given the pos­si­bil­ity that Repub­li­cans will move to elim­i­nate or limit the author­ity of the CMS In­no­va­tion Cen­ter.

HHS sec­re­tary-nom­i­nee Dr. Tom Price has called for the CMS to “cease all cur­rent and fu­ture planned manda­tory ini­tia­tives un­der the CMMI.”

He also has crit­i­cized the grow­ing de­mands on physi­cians to re­port per­for­mance mea­sures, which typ­i­cally are a key part of val­ue­based mod­els.

“What is the so­ci­etal pay­off from all these value-based ini­tia­tives will be a ques­tion Dr. Price asks,” pre­dicted Jeff Gold­smith, a na­tional ad­viser to con­sul­tancy Nav­i­gant Health­care. “He will be dis­ap­pointed in the an­swers that there aren’t any sav­ings so far.”

As a re­sult, Gold­smith sees a doubt­ful fu­ture for gov­ern­ment-led ini­tia­tives.

Some ob­servers see bet­ter prospects for vol­un­tary rather than manda­tory mod­els.

With a vol­un­tary ap­proach, “you’re some­what let­ting the pri­vate mar­ket dic­tate par­tic­i­pa­tion,” said Clay Richards, CEO of nav­iHealth, a pri­vate post-acute care man­age­ment com­pany.

Com­mer­cial in­sur­ers al­ready have adopted vol­un­tary bun­dled-pay­ment mod­els, Richards noted. “The need to trans­form our health­care sys­tem is not go­ing away,” Richards said.

Qual­ity and pa­tient safety con­cerns sur­round the loom­ing im­ple­men­ta­tion of the 21st Cen­tury Cures Act, signed into law in De­cem­ber. It will speed Food and Drug Ad­min­is­tra­tion ap­proval path­ways for cer­tain drugs and med­i­cal de­vices.

Rep. Jim McDer­mott (D-Wash.), a psy­chi­a­trist who voted against the leg­is­la­tion, said it grants phar­ma­ceu­ti­cal com­pa­nies li­cense to sell drugs “be­fore any­one finds out what the side ef­fects are.”

The act, he said, fails to pro­tect pa­tients and to en­sure new ther­a­pies are “run through the sieve of safety.”

Other ef­forts to en­hance qual­ity and safety are likely to con­tinue, though fund­ing is a ques­tion mark if the Af­ford­able Care Act is re­pealed.

The com­ing year should see a shift away from one-off projects and to­ward build­ing “sys­tems of safety” that are “re­li­able and re­silient,” Fee­ley said. Other ef­forts in­clude re­duc­ing so­cio-eco­nomic dis­par­i­ties in health­care and im­prov­ing prac­tice con­di­tions for burned-out doc­tors.

“The pol­icy en­vi­ron­ment can cre­ate a set of con­di­tions that are ei­ther fa­vor­able or un­fa­vor­able for qual­ity im­prove­ment,” Fee­ley said. “It’s too early to tell ex­actly what that new en­vi­ron­ment pol­icy is go­ing to be.”

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