Rep. Susan DelBene: Reward Value Instead of Volume

A 2017 Department of Health and Human Services report found that 98% of accountable healthcare organizations, the predominant Medicare value-based health care model, met or exceeded quality criteria and outperformed fee-for-service providers on 81% of quality scores after participating in the program. program for three years.

In addition to qualitative results, these programs have already begun to bring savings. Between 2012 and 2020, ACOs collectively cut $13.3 billion in spending and generated $4.7 billion in net savings for Medicare. Already, estimates show that 40% of healthcare dollars are tied to value-based programs, with the goal of increasing that share in the future. These are astounding numbers that, if scaled up, could help ensure Medicare pays for decades to come.

For all their potential, value-based care programs are at risk of losing ground due to changes in federal policy. In 2019, the Centers for Medicare and Medicaid Services made changes to the structure of the ACO. While this redesign was ostensibly intended to bring more visibility to health care providers, it did not take into account the significant investment that health systems must make to participate in these programs, which are still largely voluntary. On average, ACOs invest $1 million to $2 million a year in care reforms that improve patient outcomes.

Larger systems have the resources to deliver value-based programs, but if we’re going to make this service available to more Medicare recipients, we need to make sure there are incentives and protections that encourage participation. Since the 2019 changes went into effect, for the first time since the inception of the ACO program in 2012, fewer vendors have participated.

There are common sense changes the federal government can make to renew its commitment to reward value for volume as well as ensure that Medicare dollars are used most efficiently. This includes encouraging greater participation in ACOs and other advanced alternative payment models.

We can’t turn our backs on value-based care right now. That’s why I, along with Representatives Peter Welch (D-V), Darin LaHood (D-Illinois), and Dr. Brad Wenstrup (D-Ohio), introduced the Value in Healthcare Act to help more providers join value-based programs. While the Biden administration has recently proposed changes consistent with my bill, more needs to be done. This includes congressional renewal of ACO incentive payments that expire at the end of this year.

These programs have clearly shown that, when designed right, they can improve the health of our seniors while saving much-needed Medicare resources.

Download the Modern Healthcare app to keep up to date with industry news.