Consensus builds that GOP will keep value-based focus for healthcare reimbursement

By Susan Morse

Another report suggest value-based payment models will continue even, if in a different form, under the new administration's governance of the U.S. Department of Health and Human Services, according to a Health Affairs report.

"The election of Donald Trump might change the strategy of advancing healthcare reform, but the movement toward value-based care both preceded the Affordable Care Act and has bipartisan support," the authors said.

If Tom Price is confirmed as secretary and Seema Verma administrator of the Centers for Medicare and Medicaid Services Administrator, the agencies will support new value-based payment models said authors David Muhlestein, Natalie Burton and Lia Winfield.

But Price has already voiced his opposition to mandatory models such as bundled payments.

CMS, which has 74 healthcare initiatives and programs in different stages of research, testing, and adoption, recently proposed to make its cardiac care bundle mandatory and said opportunities exist for bundles that consider multiple chronic conditions.

While payment innovation may continue, the agency needs to articulate its overall strategy in four focus areas, the authors said.

The first is the expansion of the population-based model and disease-specific model.

As for accountable care organizations, they will need to expand the type of healthcare providers they work with to include behavioral health, post-acute care and pharmacy providers. ACOs will also need to consider the socioeconomic needs, such as transportation, housing and education of their patient populations.

CMS has relatively few disease-specific models beyond the oncology care model and the comprehensive end-stage renal disease care model.

As ACOs demonstrate success and more physicians have confidence in accountable care, ACOs need to take on more risk and move beyond shared savings-only.

The Medicare Access and CHIP Reauthorization Act recently established the quality payment program, and physicians with Medicare patients are mandated to be in the program through one of two models. MACRA passed with wide, bipartisan support.

The merit-based incentive payment system, which gives payment adjustments based on a set of measures and is budget neutral, meaning a negative payment adjustment will occur for underperformance. On the other hand, there's more risk but more reward in an advanced alternative payment models.

CMS needs to encourage multi-payer programs such as the one in Maryland.

Multi-payer initiatives spread cost among different insurers -- for example, commercial and Medicaid -- and provide a shared incentive to improve quality and care, the authors said.Maryland, Vermont and Colorado have programs designed to improve primary care through promoting care coordination, health management, patient-centered care and disease prevention.

Comprehensive Primary Care Plus, or CPC+, uses a regionally based multi-payer payment model to strengthen primary care. It has currently been adopted in 10 states and exists in participating counties in four additional states.

Another state-level initiative, 1115 waivers, provides flexibility to states in how they implement Medicaid expansion. So far, six states have received waivers.

A different program, 1115 demonstrations, also are available and allow states to develop their own innovative pilot programs for Medicaid that focus on expanding eligibility, improving outcomes, and strengthening the quality and efficiency of care.

"For some physicians, particularly specialists, aligning different payment models might make more sense than being restricted to a single model," the authors said. "For example, participating in different bundled payment programs could benefit a specialist who has less influence than a primary care physician over a patient's overall health management."