Healthcare News & Insights

Value-based care: The newest initiatives

ThinkstockPhotos-177798684The feds have already put several value-based payment initiatives in place for Medicare. They’ve also recently pledged to work with private payors, states and other providers to expand this system of reimbursement. 

And they’ve just released more details about how they’ll accomplish this through the newly established Health Care Payment Learning and Action Network.

Recently at the White House, President Obama hosted representatives from the Department of Health and Human Services (HHS), insurers, providers and state governments to discuss the future plans for the Learning and Action Network, according to a news release.

Ultimately, the network is designed to improve healthcare quality throughout the country. Instead of just focusing on Medicare patients, members of the network will take a broader look at patient care throughout the nation for people with a variety of insurance plans.

The Health Care Learning and Action Network hopes to repeat some of the success that Medicare value-based programs have had with improving quality of care, including the millions saved through Medicare’s accountable care organizations and the decrease in hospital readmissions after Medicare started pushing facilities to cut back on preventable readmissions within 30 days.

Examples of programs

Right now, several states and private payors have created their own value-based initiatives through the network. Here are a few examples of what’s out there so your hospital will know what to expect, straight from HHS:

  • Cigna. The private payor has adopted the same goals HHS has for Medicare when it comes to value-based payments – 90% of payments through value-based initiatives and 50% of payments from alternative payment models by 2018. And it’ll give healthcare providers who care for vulnerable patients incentives for providing quality care.
  • Dignity Health. Dignity Health has pledged to distribute 50% of its payments through accountable care initiatives by 2018, increasing to 75% by 2020.
  • State of Delaware. The state of Delaware has made its own goals for value-based care, saying that 80% of its population must receive care through value-based payment plans and service models within five years.

Even private businesses are getting involved with value-based care, including:

  • Rite Aid. The drugstore will educate employees about using alternative network options designed to improve health outcomes and lower healthcare costs. Ultimately, Rite Aid wants over half of its health insurance budget controlled by alternative payment models by 2018. It’s going to do so, in part, by creating its own internal programs with the same goals as value-based care models. Example: The company’s Rite Aid Health Alliance will pair drugstore pharmacists and health coaches with primary care providers to help patients manage multiple chronic conditions.
  • Caesars Entertainment. This year, the national casino chain launched a bundled payment project for specific surgeries such as hip and knee replacements in a handful of its markets. The costs of these bundled surgeries are much lower than traditional means of payment. If the project’s cost-saving targets are achieved, Caesars will expand the model to its other markets, potentially lowering costs for up to 29,000 employees and 23,000 of their dependents.

How hospitals should react

Hospitals need to be on board with these changes. But they’ll also need support from the feds, payors and other healthcare providers to ease the transition.

As written in a statement about the new Learning and Action Network from the American Hospital Association, “Accountable care organizations, bundled payment models, medical homes and other models could hold great promise for moving us down the pathway to more coordinated care, but structural changes – such as knocking down barriers that impede hospitals and physicians from working more closely – are needed.”

Hospitals may need to break down these barriers themselves by taking a proactive approach and reaching out to primary care providers and specialists in their area. Creating your own relationships with other healthcare providers can help pave the way for better care coordination and improved patient outcomes.

Taking the initiative is also wise when it comes to value-based payments from private payors. A hospital’s best bet is to reach out to its top payors and find out their plans for value-based care initiatives.

It may be a good idea to get in on the ground floor instead of waiting for these arrangements to be mandatory. That way, you’ll have an idea of what specific improvements your facility needs to make to provide higher quality care and get the maximum reimbursement.

It’s also smart to keep an eye on any state-specific or business-specific developments and initiatives related to value-based care from the Learning and Action Network. Being an active participant in these endeavors will be beneficial to hospitals looking to survive as value-based payment becomes the norm.

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