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Wider adoption of value-based care (VBC) would be a boon to our healthcare system by lowering costs and improving outcomes for all three P’s: patients, providers and payers.
The Centers for Medicare and Medicaid Services (CMS) has led the charge on driving VBC adoption with a series of specialty VBC programs, including July’s launch of the Guiding an Improved Dementia Experience (GUIDE) Model. GUIDE will build off the success of the ESRD Treatment Choices (ETC) and Enhancing Oncology models.
Alongside CMS’ leadership, a wave of VBC companies has emerged in recent years, mostly focused on primary care providers (PCPs) serving the senior population. While they’ve found some success in helping stakeholders transition from fee-for-service to VBC models, several headwinds are hindering further adoption across the broader landscape of primary care and specialty care, as well as additional payer lines outside of Medicare Advantage, such as Medicaid and Commercial.
The COVID-19 pandemic led to once-in-a-lifetime patient behavior swings that harmed both value-based and fee-for-service providers. Utilization of elective procedures plummeted, resulting in a drop in the government estimate of how much money was required to care for each patient. Once the pandemic subsided, utilization jumped well above historical benchmarks. Now, many VBC companies spend more on care while facing more government reimbursement challenges.
VBC still has tremendous potential, but advancing it will require innovation that unlocks new stakeholder participation and drives collaboration across the care journey. There are three significant areas of opportunity to accelerate VBC adoption and manage costs downstream.