Amid a seemingly endless transition from the traditional fee-for-service to value-based and alternative payment models, experts widely agree that the premise of Medicare Advantage that cost, quality and experience are rewarded is at the very least directionally correct.
The question for provider organizations is how do we shift the overall health system to focus on value-based care across Medicare, Medicaid and the commercial markets?
From a market perspective, it’s clear that density matters because it’s revenue passing through a practice, office or a particular hospital. You have to be able to establish a credible enough base to work from a risk perspective.
Payers can take incremental steps toward risk-based arrangements to support providers, including innovative or alternative care models that are not necessarily expensive for the plans but serve to move providers away from the fee-for-service mentality,
It is important to think of it as a partnership. Plans are more sophisticated in dealing with risk than providers are, so it’s a matter of thinking long-term about how to get there and that means we need to be fair and transparent and share information to providers so they can comfortably achieve higher and higher levels of risk over time
Barriers to overcome
1. Fragmented purchasers, no consistent contract standards,
2. The inability to translate Medicare Advantage models to commercial options and
3. Restrictive state or federal policies.
In addition to those, the shortage of people experienced in managing risk, a need to retrain staff to move beyond the fee-for-service mentality, lower margins associated with commercial risk, and bringing self-funded employers into risk-based programs.
There is no one-size-fits-all for different patient populations because they need different levels of care.
What strategies have you used for successful management in the transition to value based care?