The Centers for Medicare & Medicaid Services (CMS) published a policy statement, titled “Pathways to Success,” on changes to the Medicare Accountable Care Organization (ACO) program. In issuing the new policy statement, CMS Administrator Seema Verma said, “From the moment I became Administrator of the Centers for Medicare & Medicaid Services, I have been committed to using every tool at my disposal to move our health care system towards value-based care. This is not only a priority for CMS, but under the leadership of Secretary [Alex] Azar and President [Donald] Trump, the entire administration is aligned towards achieving this goal.” This statement is perhaps the strongest sign in a series of statements from the current administration that the trend toward value-based care will continue unabated. It comes as welcome news for organizations that have worked to move the US to a value-based model. Discern Health is proud to have been a part of this movement since the firm was founded in 2004.
For over 15 years, value-based care has been a central pillar of US health care policy, supported by both Republican and Democratic leaders. The federal government’s commitment to value-based care began under George W. Bush, whose 2006 executive order directed federal agencies to develop “approaches that encourage and facilitate the provision and receipt of high-quality and efficient health care. Such approaches may include pay-for-performance models of reimbursement.” The move to value-based care continued under President Barack Obama, who said in a 2009 speech, “We need to give doctors bonuses for good health outcomes—so that we are not promoting just more treatment, but better care.” The Affordable Care Act included many provisions that have moved value-based care forward. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has further expanded value-based payment models in Medicare.
In addition to the federal government, numerous states have implemented value-based care models. According to a 2017 report from Change Healthcare, more than 40 states have initiated plans to move toward value-based payment. Numerous private sector purchasers, such as health plans and employers, have also adopted value-based care as a key strategy during the past decade, and many are reporting significant progress in improving quality and managing cost.
Advocates for value-based care were concerned after the 2016 presidential election that the trend toward value might be slowed or halted, so the recent statement from Administrator Verma is encouraging. Given the need to ensure value-based care is working for patients, clinicians, and purchasers, the current administration will likely continue to modify and refine value-based care programs. The Meaningful Measures initiative, announced in 2017, and the proposed retirement of numerous MACRA measures are evidence of this ongoing evolution. The proposed changes to the ACO program are another example. However, such refinement was always necessary, as value-based care is still in its adolescence and best practices are still emerging. Policymakers, regulators, and health care providers are still learning how to design and implement these programs to serve the interests of patients and improve overall performance.
Discern Health closely monitors these developments and works with public and private clients to navigate a path forward toward value-based care. To discuss our work on value-based care policy and program design, please contact Guy D’Andrea at firstname.lastname@example.org.