November 03, 2017

Briefing Highlights Health Care’s Shift to Value

Multidimensional aspects of transforming health care to drive value were addressed at an Oct. 30 Capitol Hill briefing by the National Institute for Health Care Management Foundation.

Michael E. Chernew, PhD, a Harvard Medical School professor of health care policy, discussed moving from fee-for-service models to value-based payment. “Alternative payment models tend to shift accountability and risk,” he noted. “The key to a successful transition to value-based payment lies in balancing both risks and incentives in a way that works for providers, insurers and consumers,” he said.

Curtiss Barnett, president and CEO of Arkansas Blue Cross and Blue Shield, focused on successes from the Arkansas Payment Improvement Initiative. A patient-centered medical home pilot program begun in 2010, for example, lowered hospital readmission rates, ER visits and ER-related costs and increased appropriate ER utilization and generic drug prescriptions.

A value-based compensation initiative, also in Arkansas, seeks to improve care coordination and to identify and reward value. “These objectives are best met through robust public-private partnerships because more value can be created by working together than working alone,” Barnett said.

David Anderson, president and CEO of two Blue Cross Blue Shield programs in New York State, described how primary care physicians don’t get rewarded for performance under the fee-for-service model. “The fee-for-service model incentivizes an increased number of visits rather than an efficient solution necessitating the need for a move to a value based reimbursement program, “ he said.

Avik Roy, opinion editor for Forbes magazine, laid out a rationale for value-based health care from differences between net prices and acute consumer costs addressed in his white paper, “Competition Prescription: A Market Based Plan for Making Medicines Affordable,” published in May 2017. Based on his rationale, Roy said a move to value-based compensation initiatives would likely help drive down prescription drug prices.