On June 18-19, I had the pleasure attending the 10th National ACO Summit conference in Washington, DC. It’s an annual opportunity for health care leaders from across the country to be part of a discussion that focuses on policy, regulations, and legislation as it relates to value-based care.
Over the course of two days, we heard from some of the industry’s top thought leaders from both the public and private sectors, including: The Dartmouth Institute for Health Policy and Clinical Practice, Center for Healthcare Quality and Payment Reform, and Blue Shield of California Foundation. Adam Boehler, Deputy Administrator and Director, Center for Medicare and Medicaid Innovation (CMMI), provided the keynote address.
There were three topics and insights that kept re-emerging:
Move to Capitation (Get off fee for services; some risk is necessary)
There has been strong bi-partisan support of value-based care. In his keynote address, Adam Boehler identified four key components in a value-based model that work: simplicity, predictability, transparency of data, and multi-payer. One of his primary goals is to get rid of fee-for-service entirely, which he indicates would reduce the administrative burden and allow physicians to spend more time with patients. Many of the other speakers also supported the capitation model—and everyone agreed that some risk is necessary, although how much risk was a topic of debate.
Ezekiel J. Emanuel, MD noted that we need at least 25% of the doctor’s salary to get their attention- upside or downside. Barbara L. McAneny, MD, FASCO, MACP President, American Medical Association also noted that we need to Move away from fee for service which typically discouraged physicians from doing the things that patients need vs. the things that pay.
Medicare Advantage in Value-based Care (A focus on Multi-Payer Models)
As the senior population continues to grow, and before a larger proportion of the provider’s patient panels, providers and insurance plans will need to understand how to take care of an aging population. As more patients enroll in MA, it will become the nation’s largest value-based payment payer. 30% of Medicare payments are MA, and that number continues to rise. In fact, 27% of major US health systems intend to launch a MA plan in the next 4 years. Only 29% felt confident in their organization’s ability to do so.
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Quality measurement presents an administrative burden and there are lots of barriers and difficulty in reporting—with more and more financial consequences. However, there wasn’t agreement around whether we should have less measures or more measures. Since quality measurement creates an administrative burden, Ezekiel J. Emanuel, MD called for fewer quality measures. However, Mark D. Smith, MD, MBA Co-chair, Guiding Committee, Health Care Payment Learning and Action Network called for more quality measures: Unfortunately, there isn’t a set of measures that every specialty can be graded on, so we need to identify the measures that are relevant to a given specialty. One thing that was made clear, as we move toward a multi-payer model, it will be increasingly more important to get alignment of quality measures across payers.
The healthcare landscape continues to transform, but after attending the National ACO Summit and listening to some of the major leaders in the industry, it has become apparent that rapid change is to be expected much sooner than anticipated. Capitation, or at least the removal of FFS is going to take place and is being pushed strongly by CMS. Additionally, Medicare Advantage is on the rise, which means that organizations will need to be able to analyze data and implement initiatives across all payers. Lastly, quality metrics are only going to become more and more prevalent as value-based payment comes to the forefront. I greatly enjoyed the conference and I look forward to my next.