All Agility Agents,
Fee-for-service healthcare is just about done.
What’s coming in its place?
Something called “Value Based Care (VBC)”, a concept gaining significant traction in Medicare that is the “trend setter” of healthcare in our nation.
The commercial and individual insurance worlds often follow Medicare policy initiatives due to the size of the Medicare insurance marketplace. The financial implication for this change is significant regarding waste and duplicative services, as well as the potential to increase revenue by meeting quality and value measures.
Jake Frost of Patient Care Health (PCH), an Agility Holdings Group LLC subsidiary and one of the leaders in VBC for healthcare, shared his thoughts as a subject-matter expert on this in an internal discussion we had on this subject I share below.
“It is rare to experience any industry completely changing the way services are incentivized and compensated. Industry change of this nature creates incredible opportunity, and we are right on the cusp. VBC has been talked about forever which naturally leads to fatigue and begs questions about whether the promises will ever be fulfilled.
“Things will remain murky until the dominant players more fully emerge in the next 5-10 years. Look for where payers and providers are investing in VBC to support the industry’s commitment to CMS’ 2030 VBC objectives.”
Frost lists some keys, directly taken from the article linked to at the end of this blog, summarizing key aspects of a Becker Healthcare article on this subject. Those keys are:
• Quality measures digitized by 2030
• CMS’s push toward interoperability and digital health
• Easier for hospitals to track their performance in real-time (replace “hospitals” with “independent physicians” and the value point remains the same)
• More data being collected electronically
• Hospitals will need to invest in robust digital infrastructure
• The financial stakes of value-based care are enormous
• Failing to meet CMS’s quality metrics can lead to substantial penalties
• While success can result in significant rewards
• Improving care for people on a macro level
“We’ve talked about value-based care forever, almost to the point where people are like, ‘Oh, whatever, we’ll just keep doing our fee-for-service thing,’ but that day is running out,” said Eric Leroux, MD, chief quality officer at Eisenhower Health in the article linked to below.
Frost ends his thoughts with, “I agree with Dr Leroux even if 2030 still seems far out. The investment and building to manage VBC is not an overnight fix. I believe there will be an event horizon likely within the next 3 years where those who haven’t made the investment in VBC will not be able to catch up to those who have.”
VBC is coming and will fundamentally change healthcare in this nation with a change in focus to patient centered managed care with a quality focus.
Read the future below and enjoy – take care!
