![]() ![]() ![]() One of those carefully planned decisions may be to leave a legacy gift- a meaningful gift that will endure beyond your lifetime for the benefit of others- to a charitable organization like the MED Foundation of Mercer Health. We all thought we’d be further along towards value-based already, so I’ll be more measured in my view than I offered years back. We will certainly advance VBC in 2023. More commercial payers are getting more constructive on the model and providers are more aware of not only the patient benefit but the financial opportunity. And of course, Medicare has put out 2030 as the target for all beneficiaries to be treated by a value-based care provider. We’re still not to the point of leaps, but we will see gains in value-based contracts.Īmanda Schiavo is the Finance Editor for HealthLeaders.As you plan for your future, you are making a number of important decisions. Think about what will happen when all Medicare recipients are in a program. Payers get it. Big corporations get it (or are at least investing in it). Walgreens, CVS, and Amazon-all of the executives that were assigned as “talking heads” after their big acquisitions stated that the new businesses were part of their move to value-based care. ![]() HL: Do you think more providers will adopt a VBC model in 2023?ĭe la Torre: Yes. Because it works. The numbers show it. Medicare saved $1.6 billion in 2021 alone. Are they willing to work together, knowing that there is a learning curve and some economic risk to do what they originally wanted to do-provide patients with the best care, at the right cost. There are a million details that flow from there that will determine success or failure but if management and the physicians cannot agree on that first part, the venture is doomed to fail. HL: Is a VBC model financially beneficial to a hospital or health system?ĭe la Torre: It would depend on the system. For Steward, because we have been thoughtful about creating and investing in the infrastructure and the information technology backbone as well as the human capital to support the network, we routinely reap tens of millions a year in profit from our contracts.Īs to whether a hospital or health system can be successful in a VBC model, it will depend on that entity’s willingness to embrace change. That is something that physicians remain reluctant to do. ![]() If the answer to either of those questions is "no," then they are looking at a big change. To be in a VBC model, they will have to join with other physicians. That will involve some loss of autonomy no matter what the model. So, a small PCP group may be offered a VBC contract by an insurer but they need to consult with an actuary to first see if they have enough lives to take on any “downside” risk. Generally, the more downside risk you are willing to take, the greater the upside opportunity is as well. Then the group has to determine, even if they have the right number of covered lives, do they have the ability to manage the care of those patients successfully throughout the whole continuum. Then there are subtle factors like the homogeneity of populations. Obviously, patients of similar geography and socioeconomic status are easier to manage for smaller groups. HL: Are doctors and hospitals reluctant to adopt VBC?ĭe la Torre: Change is a big deal. And VBC models are a big change that requires a big scale to support the TME risk and the cost of the infrastructure. It takes many PCPs to get an ACO going. Or they can be a smaller group with a decent-sized financial backer that is hoping to invest in the smaller group as a platform for growth. But the true “currency” of the VBC/ACO model is "covered lives." And basically, only PCPs get covered lives. The VBC model works best if the patient stays within the ACO that is handling the care. First, ACO is generally linked through the electronic medical record. Second, the providers in the ACO are out of the “click” mentality and are free to focus on the right care, right time, and right place. ![]()
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