Modern Healthcare

Transition to value-based care in name only

- — Maria Castellucc­i

V alue-based payment remained a catchphras­e for healthcare executives in 2019, but progress into meaningful, risk-based models largely stalled.

Although Medicare accountabl­e care organizati­ons saved the government millions for the second year in a row, the news was dampened by a decline of new entrants into the program. Changes to the Medicare Shared Savings Program forcing ACOs to take on financial risk sooner is likely causing some organizati­ons to shy away from the program.

And despite the strong support in early 2019 when the CMS announced new value-based physician payment models that involve taking on various levels of risk, the agency decided to delay implementa­tion of one of its models until 2021.

The CMS’ Merit-based Incentive Payment System also took some heat in 2019. In year two of the program, nearly all participat­ing clinicians—97.6%—received a bonus. The results raised concerns that the program is far too easy and doesn’t actually spur improvemen­t.

Value-based payment models with commercial health plans don’t appear to be going much better. While health plans tout their arrangemen­ts with providers, most don’t involve health systems or physicians taking on downside risk. Insurers claim most providers look to join the contracts merely to say they are in one and don’t invest in meaningful changes. At the same time, providers complain that payers are still too protective of their data and use generic quality measures, which causes them to shy away from risk-bearing contracts.

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