Reforms needed to make value-based care more widespread

Value-based care plans need better alignment and sustainable business models that take advantage of advances in technology and care, says Mark McClellan, MD, PhD, director and professor of business, medicine, and policy at the Margolis Center for Health Policy at Duke University. The comments were part of a virtual presentation given at the NAACOS 2021 Spring Conference.

McClellan pointed out that more government reforms are needed to unlock the potential of value-based care plans. The payment reforms instituted to date are positive, but five out of every six dollars is still tied to some form of fee-for-service.

The pandemic illustrated that health care can change quickly when it needs to, with McClellan pointing to how he saw more telehealth usage by physicians in the first three months of the pandemic than the prior 20 years combined. “Telehealth will stick with us, especially in behavioral health,” says McClellan. “It’s more convenient, can prevent no-shows, and can overcome patient hesitancy to seek care.”

But he adds that telehealth needs to be part of a whole model of care, not a standalone option. Remote monitoring, targeted interventions and care teams that include community care workers who can help get to the root of health problems are vital. “We cannot solve problems with telehealth alone,” he says.

The pandemic also illustrated how value-based care model provide more stability to physicians. McClellan says that practices that were ensconced in value-based care plans spent less time worried about staffing levels and spent more time focusing on telehealth and digital apps to build digital care teams to keep patients healthy despite the challenges COVID presented.

Primary care physicians are vital to coordinating care in a cost-effective manner, but more needs to be done to help them.

In order to move more physicians away from fee-for-service, McClellan says they need to be provided short-term financial assistance in exchange for moving to alternative payment models.

Currently, there are too many programs from CMMI that reduce spending somewhat, but all the savings are returned to organizations based on payment adjustments. The organizations that chose to participate in many of these programs know going in that they can meet the criteria with their current setups, so it’s not really saving money for Medicare or changing behaviors.

“The lesson is, it’s hard to get significant savings in voluntary models and we need tweaks to get the costs right that provide savings,” says McClellan. “There may be the need for more mandatory pilot programs rather than just groups who think they can succeed under the rules.”

But for practices looking at value-based care, the staffing, infrastructure, and data collection expenses make it hard to implement these changes while in fee-for-service, thus the need to provide money upfront. In addition, much of the infrastructure for data collection, sharing, and management needs to be built out. This includes funding for broadband plus the support for community programs.

McClellan also said the emphasis on value-based care isn’t just about cost, but also about taking meaningful steps toward addressing health inequities. Value-based care looks at the root causes of health issues, including social determinants of health, and gets populations moving in the right direction, but that can’t be done effectively under fee-for-service. “Why we’re doing this is we are going to get better outcomes and lower costs, but it’s also about building a better health system for everyone,” says McClellan.