Reversing the Trend of Slowing Adoption
In the past years, the healthcare industry has seen a slow or stagnant adoption of value-based arrangements. According to the Catalyst for Payment Reform National Scorecard, over half of all commercial payments made in 2017 were value-based reimbursements, but ninety percent (90%) of those payments were still based on a fee-for-service structure. In response to this slow adoption trend, Medicare Advantage plans have continued to adapt and offer new opportunities for value-based payment models.
Several large payers have utilized their Medicare Advantage involvement to facilitate the full adoption of value-based care within their systems. While each payer has a distinct structure, it is the hallmark of the Medicare Advantage plan itself – “flexibility, community-orientation, provider resources, and quality measures” (healthpayerintelligence.com) – that makes the adoption of value-based care an attractive proposition.
While traditional Medicare plans have been bogged down by ever-changing regulations, Medicare Advantage has seen the opposite. With each passing year, the restrictions have lessened, so much so that in 2020 the rules were changed to allow “benefits such as meal delivery, transportation for non-medical needs, and in-home services” (healthpayerintelligence.com). Changes such as this have allowed payers and providers alike to adopt a more targeted, community-specific approach, which, in turn, has led to increased confidence in the efficacy of value-based care models.
The pre-existing community relationships that providers now have access to through Medicare Advantage plans are invaluable in understanding and meeting the needs of their communities. Payers and providers alike have found that improved patient outcomes stem from community-oriented solutions. Similar to the benefits touched on above, many of these MA solutions address social determinants of health, which oftentimes have a more profound impact on overall patient health and wellbeing than clinical care alone. Preventative actions and care are at the heart of many of these initiatives, closely aligning them with the principles of value-based care, which ultimately facilitates adoption.
Medicare Advantage plans serve to strengthen the collaborative relationship between payers and providers. Many large payers have the data and relationships, such as claims data and community resources, to implement value-based care, but many providers do not have access to such robust resources. In the cases of some payers, they have stepped into a supporting role, making “follow-up phone calls or home visits to ensure members receive the necessary care” (healthpayerintelligence.com). Other payers who have the benefit of a vertically-integrated system have seen great success from the agile, collaborative relationships between themselves and their providers. Greater collaboration between payers and providers leads to a greater understanding of the importance of value-based care adoption on both sides.
Quality measures ensure that payers, providers, and members are receiving the greatest benefit from their Medicare Advantage plans. Quality measures are crucial in supporting the ultimate goal of value-based care, which is to provide the highest quality care at the lowest possible cost. Many payers and providers have included patient and provider experience as metrics in their quality measures, leading to improvements and innovations for all parties involved. The sharing of key patient insights from payers to their providers has led to increased feelings of partnership in what has been a somewhat acrimonious relationship in the past. These shared goals set out by Medicare Advantage are rooted in the principles of value-based care, specifically the importance of preventative care, and make the shift to value-based agreements all the more attractive to payers and providers alike.
Innovista Health Solutions is a population health management company that offers management and support services to guide independent physician networks, medical groups, and health systems through the ever-changing landscape of value-based care. With services and toolsets including network development, population health management, delegated services, data reporting, and strategic capital investments, Innovista is structured to help its clients succeed in their Commercial, Medicare, and Medicaid value programs. Innovista is a single resource for physician integrated models to gain access to innovative technology, expert programs, actionable data insights, financial resources, and growth opportunities, to navigate and succeed in value-based and/or risk-based contracts.
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