Value-based care continues to find its way into the healthcare sector. It is clear that the future of reimbursement will include at least a large chunk of providers paying for value rather than volume.
So when the new year approaches Healthcare IT news has teamed up with a value-based care expert to hear their views on what will bring for the payments system in 2022.
Tim Gronniger, President and CEO of Caravan Health, was previously Chief of Staff and Director of Delivery System Reform at the Centers for Medicare and Medicaid Services. Caravan Health is a privately held company founded to develop sustainable methods for health systems that are characterized by value-based care. In 2019 and 2020, its partners achieved $ 300 million in Medicare savings, more than $ 120 million in joint savings, and quality ratings of over 97%, the company reported.
Tim sees four important areas for value-based care in 2022: telemedicine, employee loyalty and burnout among service providers, equal health opportunities and growth in value-based remuneration.
Q. When the public health COVID-19 emergency began in 2020, healthcare providers quickly turned to making the most of the temporary flexibility of telemedicine. While Congress and CMS have considered expanding access to telemedicine and virtual care on a permanent basis, this comes at a high price. What do you think will happen to telemedicine in 2022?
A. Telemedicine has made a huge difference in delivering adequate care to patients since the pandemic began. The COVID-19 public health emergency – and its expanded telemedicine flexibilities – will last at least until early 2022. We hope to see some movement in permanent telehealth before the end of PHE.
Prior to the pandemic, telehealth services in paid Medicare were mostly limited to rural areas where patients travel to a health facility known as a point of origin for treatment by a provider who is also located at a health facility called a remote Page.
Even in rural areas, it was not easy to use these pre-PHE authorities. Patients typically had to drive to their doctor’s office, and offices had to have video and audio equipment and maintenance.
An abrupt end to telemedicine would create access problems for patients who have become accustomed to accessing quality care more conveniently. Vendors have invested in equipment and services to provide this vital source of supply, and these investments should not be abandoned.
CMS has taken government action to increase the availability of telemedicine. While Congress is considering what elements of the current regime to expand, it should prioritize telemedicine through accountable care and other value-based care arrangements that allow clinicians to select the most appropriate, high-quality treatment.
Sometimes this is done personally, sometimes remotely, but in both cases providers internalize these costs in responsible care agreements. Cost controls are built into these programs so that telemedicine cannot increase overall costs.
By linking telemedical reimbursement with value-based care, patients have access to telehealth services because this is the most appropriate care for the situation at hand, not because it is more profitable than personal care.
Q. The increasing demands on clinical staff have resulted in staff burnout, which threatens access to health. They say population health and team-based care can be effective ways to retain staff and improve hospital satisfaction. These vaccine retention concerns are compounded by the introduction of vaccine mandates. What can healthcare provider organizations do in 2022 to combat burnout and retain employees?
A. Health care organizations need to pay close attention to the satisfaction of clinical and non-clinical staff.
Team-based care means that the patient is at the center of care. For years we’ve been talking about the importance of the triple goal of increasing quality of care, reducing costs, and improving the patient experience. In 2022 and beyond, we need to make sure that clinical satisfaction and fate are not overlooked.
This is an important issue given the widespread concern about doctor burnout. We need to have an honest discussion with our teams about the trauma they experienced at the end of the second full year of the pandemic.
We need to provide resources to providers, including advice and even just time to recover. It is not easy while staffing is scarce, but it is important.
Federal vaccination regulations aren’t that old, but many providers have been working hard for months to meet government, local, or individual health system requirements. Even with new requirements, the approach to employee loyalty should remain the same: create a pension system that works for everyone.
Engaging the entire team in a proactive primary care system is key to distributing the work and putting resources where they can work best.
Q. The racial, ethnic, and income-related health gaps in the United States are persistent and not easily resolved. They argue that traditional fee medicine pays service providers for the scope of the service and does not adequately compensate service providers for health promotion and the prevention of acute illnesses or the development of chronic illnesses. How can value-based care help in 2022 and beyond?
A. Traditional service fees pay for services provided to patients. The more services are provided, the more the provider is reimbursed. The incentives are to treat illnesses rather than paying providers to keep people healthy and out of the hospital. We need to flip this model for the best results.
In a value-based care model, the providers have the incentives to create care that is geared towards the health of the population and to save money while the beneficiaries stay healthy. The incentives of a values-based care model can be useful in addressing the persistent health disparities in our country. Metrics related to social determinants of health and the reduction of health disparities can be incorporated into these models and refined.
Our customers today focus their energies on serving their sickest patients. I fully expect and welcome that CMS and other payers will soon hold us accountable for improving clinical outcomes in minority groups, and we stand ready for that.
For value-based payment providers, assessing the health needs of different population groups and taking into account the social factors that affect health are not cost drivers, but rather the incentives of holistic care that ultimately saves money.
Q. CMS recently announced a goal of helping all Medicare beneficiaries by 2030 through accountable care or other agreements on the total cost of care. They believe this goal is a step in the right direction for our healthcare system, which too often paid by volume rather than value. However, CMS cannot do this on its own. How are ACO management and other organizations helping guide providers through value-based payment?
A. The most encouraging part of the Center for Medicare and Medicaid Innovation (CMMI )’s goal to increase the total cost of care agreements is the explicit link to achieving equitable outcomes for patients.
The CMMI leadership continues to focus on the outcome of the major healthcare system transformation. ACO management organizations are in daily contact with these providers and know the specific concerns and entry barriers. Companies that specialize in building and managing ACOs have proven that they can hold all types of providers accountable with strong quality and financial results.
This goal of greater participation in responsible care is shared by other key players in value-based care.
MedPAC recently viewed innovative benchmarking changes for ACOs as being more attractive and realistic to attendees. Benchmarks are the key to saving together – an important success factor for every ACO participant. CMS also raises fundamental questions to make benchmarks fairer and more predictable.
It is possible that we will see policy changes that appear like technical changes to benchmarking but are critical to attracting more participants to sustainable, value-based care relationships. This may include fixing the “rural bug” or fixing the HCC risk score cap. Both were discussed but not finalized in the Medicare 2022 Physician Fee Schedule.
Twitter:@SiwickiHealthIT
Email the author: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
