As factions war over the future of the Affordable Care Act, the only visible consensus is that change is necessary to ensure that consumers have access to affordable care that puts the patients’ needs above all else. As the debate over “repeal and replace” rages in Washington, payers and providers, working with employers and patients, are working toward their own market-based solutions.
The status quo of fee for service health care benefits no one in the long-term. That’s why the members of the Health Care Transformation Task Force, an industry consortium that brings together patients, payers, providers and purchasers to align private and public sector efforts to transform the U.S. health care system, is not tinkering with fee-for-service payment models, it is advocating a new paradigm of innovative value-based payment and care delivery. This model reconciles what many consider competing values: access, affordability and a patient focus. To understand the transformative nature of value-based models, these are the five things policymakers and patients should know:
- Value-based care is patient-centered care.
Value-based care puts patients first by promoting affordable access, transparency, and choice in health care. Through effective care coordination and aligned incentives, purchasers, payers and providers can effectively reduce the cost of care and improve quality and outcomes for patients and their families.
- Incentives and accountability create better outcomes for patients.
Value-based care promotes financial incentives that reward the value of care provided, not the volume of services ordered. The focus is on a patient’s unique situation and experience, whether the provider or health plan is accountable for the patient’s total well-being or for effective management of a specific episode of care.
- Realizing the benefits of value-based care requires commitment and investment.
The transition to value-based care is challenging, and requires a significant and sustained commitment over a period of years to be successful. The investments necessary for success are not just financial and infrastructure-related; cultural change and buy-in from a myriad of stakeholders is also critical to long-term sustainability.
- Value-based care works when every stakeholder is engaged.
Organizations committed to sustainable change must plan for all of their business to move to value-based care over time. This requires alignment between the public and private sectors in their commitment to value-based care, which has received bipartisan support among federal policymakers. The private sector is not seeking subsidies, but it needs to know that the largest payer, the Federal Government, will also function within the same framework. Plans and providers must push forward with their transitions to pass that critical tipping point where all of their care delivery is paid based on value and not solely on volume.
- Value-based care doesn’t just benefit patients; it’s an economic engine that creates jobs.
The change to value-based care is an economic engine as well as an improvement in care delivery. It involves investment in new technologies that help coordinate care and record and share patient data. Entrepreneurial businesses have emerged that support health plan and provider transition to value-based care, attracting significant investment from the capital markets. New jobs are being created around care coordination and other aspects of value-based care delivery and data-sharing. Tech companies have developed consumer-centered data technology that allows patients to be the keepers of their own medical information.
While these points are important to understanding the benefits of value-based payment models, what must be underscored is that these models can rise above the partisan fight. Politicians can have their cake and eat it too. Value-based care offers a consensus framework for the payment and delivery of care that realigns incentives so that patients truly come first.
For almost two decades, the federal government has played an important role to accelerate the transformation to value-based payment. As the Trump Administration and Congress seek to deliver on the promise of affordable and accessible health care, they should stay the course on value-based payment. They will find willing private-sector partners who have made significant investments in a value-based future, and are working hard to fulfill its promise.
Many organizations are nearing the tipping point for realizing sustainable change, but unless the government sends a positive signal of support for continued transformation, continued changes in the delivery of health care that improve cost and quality may slow or stop. That’s a future we can’t afford.
Jeff Micklos is the Executive Director of the Healthcare Transformation Task Force.
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