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Prioritizing the shift to value-based care has been at the forefront of the healthcare industry. But the road to transitioning from fee-for-service to value-based payment models is not always smooth.
Convincing payers of value-based care’s feasibility is no longer the issue. The problem lies in the fact that basic healthcare operations do not support value-based care models, according to Patrick Gordon, chief executive officer of Rocky Mountain Health Plans (RMHP) in Colorado.
“The case has been made; payers understand what this can produce. We certainly do when we look at our value-based programs and networks,” Gordon told HealthPayerIntelligence. “It’s just a very heavy lift to overcome decades of optimization of a fee-for-service model to something that’s fundamentally different.”
RMHP, a UnitedHealthcare company that serves Medicaid and Medicare Advantage beneficiaries, focuses on promoting value-based payment models, especially in rural areas. The health plan began its value-based care journey over ten years ago.
“We realized, with the opportunity to expand Medicaid coverage and also to expand coverage in the individual marketplace, that we needed payment models that promote capacity in an already stretched network, particularly around primary care which is the foundation of any healthcare system and the foundation of population health,” Gordon said.