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The new future of value-based care

Join McKesson and the Avalere team as we deep dive on the future of value-based care and telehealth, answering questions on how providers should be preparing for future value-based care models, including CMMI payment models such as the Home Health Value-Based Purchasing Model and Advanced Primary Care. Additionally, the webinar will discuss telehealth flexibilities put in place during the public health emergency (PHE), and how telehealth may evolve after the PHE.


  • Lauren Cricchi, consultant I, Avalere Health | With expertise in quality measurement and value-based contracting, Lauren works with life sciences companies, provider groups, health plans, employees and disruptors to identify strategic engagement opportunities within the Medicare and commercial quality- and value-based programs, analyze quantitative performance results and assess policy implications across the healthcare industry
  • Brigit Kyei-Baffour, associate principal, Avalere Health | Brigit advises clients on issues related to market access policy and reimbursement strategies for digital health, diagnostic, medical device and pharmaceutical companies. She leverages her expertise by helping clients design and optimize patient support services, assess the impact of social determinants of health on specific patient populations, and evaluate market dynamics

Jump to sections:

  • Minute 3:23 - The current continuum of value-based care
  • Minute 23:18 - Current & future landscape of telehealth Minute
  • 41:05 - Q&A

For about two decades, the U.S. healthcare system has been slowly shifting from reimbursing providers for the volume of visits to compensating them for quality of care. This move toward value-based care has been largely driven by reimbursement changes initiated by the Centers for Medicare & Medicaid Services (CMS), which other payers have also adopted. The progress toward an increasing focus on value-based care is set to continue for the foreseeable future.

A long-term journey

Moving from volume-based care to a value-based care model is a journey and the U.S. healthcare system is midway through the trip. At the starting point is the traditional model of paying providers for volume. Next, the healthcare system moves into paying for performance and the eventual destination is paying for a higher value. Currently, "we're in the in-between phase of paying for performance," Cricchi says.

For example, 41% of healthcare payments currently flow through alternative payment models not based on volume.

That includes:

  • 35.5% of commercial payments
  • 58% of Medicare Advantage payments
  • 42.8% of traditional Medicare payments
  • 35.4% of Medicaid payments

Over time, those figures will continue to increase as CMS and other payers develop newer and better payment models that incentivize providers and drive more efficient coordination across the care continuum.

According to Cricchi, the Biden administration has announced strategic plans for value-based care that will provide greater provider payment flexibility while requiring more actionable data to assess these arrangements.

The number and type of payment models tested will reflect the current administration's priorities in the coming months and years. Cricchi offered a look at the model types primary care practitioners can expect to see on the next leg of the journey toward value-based care.

Fewer payment models with more value

The CMS Innovation Center (CMMI) is a U.S. Department of Health and Human Services agency that tests new healthcare payment and delivery models to improve care, lower costs and better align payments to promote patient-centered practices. Since CMMI's launch in 2010, the agency has tested more than 50 different payment models and only four have been certified for national expansion.

To better focus CMMI's efforts, the Biden administration has pledged to test fewer models in the future, Cricchi says. All tested models will have multi-payer alignment so that providers can utilize the model with multiple types of payers. The administration aims for all Medicare and most Medicaid beneficiaries to have a relationship with a provider using an accountable care model by 2030.

The Home Health Value-Based Purchasing Model (HHVBP) is one of the four CMMI models certified for nationwide expansion. In this model, home health agencies receive adjustments to their Medicare fee-for-service payments based on their performance against a set of quality measures relative to their peers' performance.1

On average, when tested in nine states, the model had a performance improvement of 4.6% and an annual savings of $141 million to Medicare. As a result of this success, participation in HHVBP will be a requirement for all home health agencies beginning in 2023.

Models for the future

As CMMI pursues additional innovations in value-based payment models, it will focus on five main objectives:

1. Drive accountable care. The goal is to increase the number of people in a care relationship with accountability for quality and total cost of care.

2. Advance health equity. CMMI will embed health equity into every aspect of every model studied to increase focus on underserved populations.

3. Support innovation. CMMI will leverage a range of supports for both patients and providers.

4. Address affordability. Studied models will address healthcare prices and work to reduce unnecessary or duplicative care.

5. Partner to achieve system transformation. CMMI will seek to develop innovations that will work not only for CMS but will align across other payers as well.

According to Cricchi, while CMMI pursues several different types of alternative payment models, three are most applicable to primary care:

1. Accountable Care Organizations (ACO) receive shared savings when quality and cost goals are met.

2. Primary Care First is a voluntary, multi-payer model that offers enhanced payments to support advanced primary care services. More than 3,000 primary care practices currently participate in Primary Care First models, including innovative partnerships across multiple sectors, including payers, employers and retailers. For example, Vera Whole Health partnered with J.P. Morgan to provide advanced primary care to J.P. Morgan employees in Central Ohio and Oak Street has partnered with Walmart to embed primary care providers within Walmart stores.

3. Direct Contracting is the newest, most advanced model for alternative payments. Participants, known as direct contracting entities, accept capitated payments on a voluntary basis and can offer enhanced benefits to beneficiaries. The model aims to reduce costs and improve quality of care, Cricchi says.

Embracing telehealth for the future

Telehealth emerged as an important component of providing value-based healthcare during the pandemic. By offering remote healthcare services, transportation costs, wait times and care costs are reduced, value-based care metrics are enhanced. And as we move beyond the public health emergency, telehealth will continue to be an essential avenue for providing care, says Kyei-Baffour.

In 2019, 0.18% of healthcare was delivered via telehealth methods. That figure increased to 5.61% in 2020 and remained high at 4.1% in 2021. Mental health services represent the type of care most frequently accessed via telehealth, followed by acute respiratory, joint/soft tissue disease and issues, developmental disorders and exposure to communicable diseases.

Telehealth usage increased during the pandemic largely because CMS lifted restrictions and limitations on how providers could use telehealth and how it could be reimbursed. Suddenly, providers could use their phones to deliver telehealth, be reimbursed equally for telehealth or in-person visits and see any patients via telehealth - not just those living in rural areas.

Some of those changes are expected to remain after the public health emergency has ended, Kyei-Baffour says. Telehealth is likely to be allowed in any geographic area, covering initial visits as well as visits with established patients and providers will likely be permitted to supervise delivery of care through telehealth.

However, some changes are unlikely to remain in force. Kyei-Baffour expects that providers will no longer be able to use their personal phones or non-Health Insurance Portability and Accountability Act (HIPAA) compliant platforms to deliver telehealth. Also, she says reimbursements and coding may not remain the same for telehealth and in-person visits.

As primary care providers prepare for the future, they can expect telehealth and value-based care to continue to be essential for their practices moving forward.

Webinar originally aired on February 23, 2022


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