In a letter to Congress and the new administration, several prominent healthcare organizations have called for a renewed effort to move to value-based, patient-centered payment models that reward improved quality and cost-effective care.
The organizations in the letter—inclusive of many major health systems across the U.S. and leading association groups—said that central to this effort is addressing the perverse incentives in the fee-for-service system, and antiquated laws and regulations that impede innovation and care coordination. They are calling upon Congress and the Trump administration to help them achieve this goal.
The letter to President Trump and Vice President Mike Pence reads, “Healthcare has been operating in a fee-for-service system designed more than 50 years ago. Over the years, the regulations governing this system have grown extraordinarily complex. This complexity hampers efforts of clinicians and other healthcare providers who have been diligently working to measurably improve quality, reduce costs and take accountability for populations of patients. Despite these impediments, organizations have made significant investments in building and testing alternative payment models that are designed to move healthcare forward to promote value.”
The organizations noted that the bipartisan journey toward value-based care began more than 15 years ago with pay for performance, bundled payment and accountable care organization (ACO) models. Healthcare providers, clinicians and insurers have invested significantly in moving healthcare in this direction. Policy changes and payment model improvements are critical to strengthen and expand on this movement, which is starting to generate results. For instance, Medicare ACOs have collectively generated $1.29 billion in savings since 2012 while improving quality they pointed out.
The Jan. 25 letter continued, “We, the undersigned, strongly support this movement and are committed to working with Congress and the Trump administration to build the next generation of healthcare policy. As you take up the mantle of addressing the challenge of improving quality while safely reducing costs, we strongly urge you to continue focusing on driving value-based, patient-centered payment models that incent healthcare innovation.”
Next, the organizations shared their vision for a “modernized, sustainable healthcare system” based on the following principles:
- Empower and engage patients to make healthcare decisions with information and support from their healthcare team.
- Invest in engaging patients in the development of measures of provider performance that are relevant to them and consistently and transparently reported by all public and private payers.
- Improve clinician and provider access to timely, accurate and complete claims data to better facilitate care management.
- Recognize that the socioeconomic status of many patients creates challenges in providing care, and adjust payments to providers as appropriate.
- Design voluntary payment models that incent greater participation and achieve the highest quality and cost value based on patient choice and competitive markets.
- Expand the use of waivers from fee-for-service legal and regulatory requirements that impede collaboration and shared accountability, while preserving consumer protections and safeguards against fraud.
- Build on and expand payment models that promote collaborative financial and care coordination arrangements using incentives that align payers, healthcare providers, providers of long-term care services and clinicians.
- Appropriately incent access to medical innovations and treatments that hold the potential to improve quality of care and reduce overall system cost.
- Promote public and private investment in the transparent, evidence-based testing and scaling of new alternative payment models as directed in MACRA so that clinicians, other healthcare providers and payers can learn how payment models work and evolve in the clinical setting.
- Ensure alignment between private and public sector programs, which is critical to a sustainable value-based payment marketplace.
“I am confident that the migration toward value-based care will continue regardless of what happens in the next few months,” Michael O. Leavitt, chairman and co-founder, Leavitt Partners, three-term governor of Utah and former U.S. Secretary of HHS, said in a statement. “There is a remarkable amount of bipartisan agreement when it comes to payment and delivery reforms, as evidenced by legislation like MACRA, and the Republican Congress has established a clear pattern of supporting the transition from fee-for-service to value payment.”
Added Jeff Micklos, executive director, Health Care Transformation Task Force (HCTT, “Our member organizations have committed to moving 75 percent of their business to value-based models by 2020, a move that has required a significant investment and planning. With so many organizations on the cusp of meaningful, long-term change, we need clear signals of support and a strong commitment to move value-based care forward—now and in the future.”
The letter itself concluded, “We stand prepared to work vigorously with the Administration and the Congress to expand upon the quality and cost savings progress made in America, and we look forward to taking the next steps to reach and surpass the tipping point where value-based healthcare becomes a sustainable marketplace for generations of Americans to come.”