Value-Based Model of Care Reshaping the Health Industry

VBID in Medicare

The health industry continues to reshape their offerings as the march toward providing value over volume continues at a faster pace this year. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) known as the physician payment reform law, starts its first performance year in 2017.

According to Health Research Institute’s (HRI) Top health industry issues of 2017 report, healthcare providers will be asked to participate in one of two payment tracks. One track involves traditional Medicare payments, which will be adjusted depending on how much data the physician submits to the CMS and how well they perform on certain quality metrics. The other track emphasizes healthcare providers’ abilities to positively impact patients’ outcomes, making them eligible for future bonus payments.

Value-based payment models require physicians to measure and continually improve the value, cost and quality of care they provide. Healthcare providers to some degree already foresee that their roles will change due to the impact of value-based care. According to a HRI 2015 physician study, primary care doctors believe they will spend more time analyzing data from apps and wearables, coordinating care and leading teams to manage medically complex patients.

Experts recommend that continuing medical education and training programs, even health plans should address this shift and provide learning opportunities for work in a value-based environment. Healthcare providers also need to be kept updated on new state and federal regulatory requirements. Board certifications will need to incorporate these newly acquired skills into their standards as well.

This means medical students will need training on working on cross-discipline teams and be taught a modified curriculum that incorporates value-based learning objectives. The Accreditation Council for Graduate Medical Education (ACGME) has already introduced cost considerations such as minimizing unnecessary diagnostic and therapeutic tests and risk-benefit analysis into its Common Program Requirements and Internal Medicine Reporting Guidelines.

Value-based decision-making is well on its way to the forefront. Innovative approaches are needed that help medical students and physicians learn how to measure and improve patient care and outcomes. Delivering higher quality care at a lower cost requires an analytics–driven mindset and leadership skills to quicken the pace of change.

Source:  PwC’s Health Research Institute. Top health industry issues of 2017. December 2016.

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