American Heart Association calls for transition to value-based payments

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The American Heart Association (AHA) wants the U.S. health care system to shift away from its current reliance on fee-for-service payments in favor of a value-based payment (VBP) system.

The association’s endorsement of value-based payments comes in a policy statement in the current issue of its flagship publication Circulation.

“Value-based care delivery and payment models hold the promise of producing better patient outcomes and lowering costs,” Karen E. Joynt Maddox, M.D., M.P.H., FAHA, a member of the AHA’s coordinating committee and an assistant professor of medicine at Washington University in St. Louis said in an accompanying news release. “Value-based programs represent an important but under-recognized opportunity to improve the clinician’s experience and the efficiency, quality and value of patient care.”

VBP models tie clinician reimbursement to patient outcomes and quality of care metrics rather than the number of services they perform. Slightly more than 60% of health care payments in 2020 included some form of quality and value component, up from 53% in 2017 and 11% in 2012.

The AHA policy statement contains recommendations for value-based care delivery and payment models, including:

• integrating person-centered process and outcomes quality metrics;
• improving how clinicians are evaluated relative to cost;
• embedding functional status and social risk factors into risk adjustment methodologies;
• promoting flexible funding for comprehensive, team-based care and innovation;
• ensuring clinicians have resources and capabilities to implement best practices; and
• aligning value-based care and payment programs across public and private payers.

In addition, the statement outlines principles for guiding development of future VBP models, including:

• When balancing incentives for reducing costs and improving care quality the emphasis should be on care quality,
• VBP programs should be a tool for improving equity,
• Programs should ensure flexible funding that enables clinicians to focus resources on interventions that best help patients, and
• Programs should “find ways to channel clinicians’ intrinsic motivation to improve their performance and the care for their patients.”

The AHA says its recommendations are “consistent” with the Center for Medicare and Medication Innovation 2021 Strategy Refresh that was designed to promote “a health system that achieves equitable outcomes through high quality, affordable, person-centered care.”