Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

HHS Sec. Burwell Shares Vision for Value-Based Care Future

Value-based care progress should focus on developing alternative payment models, promoting care coordination, and standardizing health data, HHS Secretary Burwell stated.

- In a recent Health Affairs blog post, HHS Secretary Sylvia Mathews Burwell called for value-based care progress after the Obama administration ends through more alternative payment models, care delivery transformation, and health data access.

A value-based care future includes alternative payment models, care coordination incentives, and standardized data sharing, HHS Sec. Burwell stated

Secretary Burwell touted Affordable Care Act successes, such as increases in insured Americans and healthcare payments linked to value-based reimbursement. But she urged future healthcare leaders to build on these successes and improve value-based care strategies.

“Improvements need to be made, but they need to build on progress and not take us backwards in terms of access (the number of insured), affordability (costs to individuals, businesses, and taxpayers), and quality (the benefits that are being provided),” she wrote.

Her strategy for furthering value-based care included supporting and developing alternative payment models, fostering care coordination and quality improvement, and making healthcare data easier to share in a secure manner.

“This is the path forward—a system where innovative actors are putting the patient at the center—and, despite differences in healthcare, I firmly believe it is a vision on which we can all agree,” the blog post stated.

The first step to achieve care delivery system reform, according to Secretary Burwell, is to continue tying healthcare payments to alterative payment models.

HHS reported in March that 30 percent of Medicare reimbursement was tied to an alternative payment model, 11 months ahead of the department’s value-based reimbursement goals.

Through its strategy, HHS also plans to meet its goal of 50 percent of Medicare payments by the end of 2018, which should act as a value-based care “tipping point.”

“The core of our strategy is this: pay directly for actions that we know drive down costs and improve care; test new payment methods that align financial incentives with evidence-based best practices; and encourage providers to take on the challenge of participating in population-based models, where they are fully responsible for the total cost of their patients’ care and a full range of outcomes,” she wrote.

But the HHS Secretary attributed value-based reimbursement success to the CMS Innovation Center, which develops, tests, and scales alternative payment models, such as accountable care organizations (ACOs) and bundled payments.

For example, Medicare ACOs saved approximately $466 million in 2015, according to recent CMS data, and generally improved quality performance.

CMS Acting Administrator similarly advocated for the CMS Innovation Center in a statement at the MACRA MIPS/APM Summit earlier this month. Slavitt stated that “MACRA can’t work as well without a CMS Innovation Center that can move quickly to develop and expand new approaches to paying for care.”

According to Secretary Burwell, the federal agency’s center has also remained committed to developing more alternative payment models that offer providers different ways to implement value-based care, including bundled payment models that encompass longer episodes, more services, and a variety of clinicians.

For example, CMS announced the Comprehensive Care for Joint Replacement model last year, in which participating hospitals are reimbursed a set amount for a full hip or knee replacement episode.

Private payer and state participation in the value-based reimbursement transition is also key, she added. In October, the Healthcare Payment Learning & Action Network reported that only one-fourth of healthcare dollars from commercial, Medicare Advantage, and Medicaid health plans are connected to a population-based alternative payment model.

Under MACRA, though, the Quality Payment Program will accelerate the value-based reimbursement transition across the healthcare sector, the blog post continued. However, the new payment model will need to be improved as it matures.

Burwell wrote:

“Implementing MACRA has just begun, and we know questions will continue to arise regarding whether we have sufficiently tailored the program to support small and rural practices, or whether there are enough alternative payment models available. To address these challenges, we plan to continue working closely with clinicians and patients, listening to their concerns and ideas, and responding to their feedback. MACRA is a significant step forward in reforming Medicare payments, but it is an iterative process. This is just the beginning.”

The next step in care delivery reform is to improve care coordination and preventive health initiatives, the HHS Secretary explained.

“If you look across the healthcare system today, the same services vary significantly in cost and quality at different providers,” Secretary Burwell wrote. “To close that gap and improve the delivery of care for every provider, we need to help Medicare transition to policies that better reward coordinated, quality care.”

A key aspect of improving care coordination is allowing primary care providers to “practice the way they think is best,” such as through the newly launched Comprehensive Primary Care Plus program. The CMS initiative prospectively reimburses primary care providers to deliver more flexible care, including access to care outside of the traditional office and times.

Prevention healthcare programs, like the Medicare Diabetes Prevention Program, should also remain a primary focus because they advance health outcomes and lower costs over the long term.

However, healthcare leaders and policymakers will need to develop care delivery transformation resources for providers, including better quality measures and data standards.

“If we can equip providers with the tools they need to test and develop new ways to provide better care, they can lead us down the road to broader, national improvement,” stated Secretary Burwell.

Burwell’s third step included furthering HHS health IT goals, such as standardizing healthcare data, giving patients access to their own information, and ensuring policies reflect that secure data sharing is crucial for market success.

Even though CMS reported in September that 96 percent of hospitals have adopted certified EHR technology, the blog post pointed out that simple and secure healthcare data sharing is still needed to support  value-based reimbursement and care delivery.

Burwell stated:

“In a better healthcare system, it should be easier for clinicians to track vaccinations or screenings, and easier to give a second opinion,” she wrote. “In such a system, patients and providers should be able to see everything that has or hasn’t worked for a given condition, so they don’t repeatedly start from square one. Easily accessible and portable electronic health records (EHRs) not only help patients move seamlessly between their providers, but they also offer patients the agency to take an active role in their care.”

HHS has taken several steps to unlock healthcare data, including reducing and streamlining EHR Incentive Program and Health IT Certification reporting, requiring more testing from health IT developers, and limiting fees that entities who provide medical records can charge.

But the healthcare industry can do more to support standardized and secure data sharing.

“With more data, continued support at the federal level, and collaboration across the industry, we can get to a system where unlocked data, in the hands of patients and their doctors, also unlocks better care,” stated the blog post.

Secretary Burwell concluded by highlighting how a potential Affordable Care Act repeal should preserve some value-based care successes, such as increased healthcare coverage, and continue on the value-based care path.

“All of this work is worth it, because we all benefit from a system that measures outcomes and rewards value,” she stated. “We all benefit from care that centers on patients and enables them to take a greater role in their healthcare. And our businesses and the entire economy benefit from a system that is more efficient and more effective.”

Dig Deeper:

What Is Value-Based Care, What It Means for Providers?

Understanding the Value-Based Reimbursement Model Landscape

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