The imperative of value-based care: How it’s going and where it’s headed

In the evolving landscape of healthcare, the transition to value-based care stands out as one of the most pivotal initiatives. Still, it has taken several years—and a global pandemic—to gain serious traction. The recent announcement by CMS highlighting the 1.8 billion dollar success of the Medicare Shared Savings Program further underscores the rise in focus on value-based care strategies and models. In this post, we’ll zoom into the national status of value-based care efforts, highlight key resources that are driving the initiative forward, and predict what the future holds.

National status of value-based care efforts

ACOs, consisting of doctors, hospitals, and healthcare providers, have been at the forefront of the value-based care movement driving coordinated, high-quality care to Medicare patients. They aim to ensure timely care while minimizing unnecessary services and medical mistakes. The model is simple but profound: when ACOs deliver top-notch care and judiciously utilize healthcare dollars, they may qualify to share in the savings they generate for the Medicare program. This not only leads to fiscal prudence but also ensures reduced out-of-pocket expenses for Medicare beneficiaries.

The CMS announcement mentioned earlier is a testament to the effectiveness of this model. The Medicare Shared Savings Program, one of the country’s most extensive value-based purchasing programs, saved Medicare a staggering $1.8 billion in 2022. This achievement marks the sixth consecutive year the program has realized overall savings and maintained high-quality performance metrics. But the move towards value-based care isn’t just about financial prudence; it’s about delivering quality care.

Beyond the financial savings, ACOs have demonstrated superior performance on crucial quality measures. They have outperformed other similarly sized clinician groups not participating in the program. Key areas of enhanced performance include diabetes and blood pressure management, cancer screenings, tobacco use assessments, and mental health screenings. These improvements resonate with CMS’ broader objectives, like the Behavioral Health Strategy and the Cancer Moonshot, aiming to elevate overall health outcomes.

The numbers are clear: about 63% of ACOs earned performance payments in 2022. Remarkably, ACOs predominantly consisting of primary care clinicians saw more significant savings, emphasizing the centrality of primary care in the success of the Shared Savings Program.

Technology trends powering value-based care success

When we consider the drivers and contributors to the uptick in adoption and execution of value-based care initiatives, there are a few key technology trends to consider.

Applying risk analysis

With cutting-edge, self-service analytics, healthcare organizations are gaining a holistic view of the risk associated with their populations. With easy access to data deep dives, organizations transform vast information into actionable insights, allowing them to stratify populations and customize support strategies with care managers. This data-driven precision has led to significant improvements in clinical outcomes.

Zooming in on high-cost members

By identifying members with extensive comorbidities or multiple chronic conditions, healthcare organizations can better understand their needs and gaps in care. With this information in hand, providers and payers are better equipped to deliver wrap-around services tailored to manage specific disease states more efficiently. This shift in approach to high-cost members goes a long way toward ensuring better health outcomes and financial stability.

Augmenting SDOH for full impact

Social determinants of health data is meaningful and useful, but when integrated with quality, clinical, and financial insights, it reaches greater potential. This approach allows healthcare organizations to pinpoint community-based initiatives that can have a profound impact on at-risk populations.

Optimizing network analysis

Network analysis is a comprehensive approach that identifies fragmented care opportunities, which ensures that patients receive the most efficient and streamlined care possible. By pinpointing misalignment of specialists within a network, this strategy helps ACOs and ensure that every patient interaction adds value and is necessary for optimal health outcomes.

The road ahead for value-based care: A vision for 2030

With over 573,000 clinicians catering to nearly 11 million Medicare beneficiaries, the Shared Savings Program’s impact is undeniable, and the evidence is overwhelmingly in favor of value-based care models. CMS has ambitiously set a goal to include 100% of people with traditional Medicare in an accountable care relationship by 2030.

Meena Seshamani, MD, PhD, CMS Deputy Administrator and Director of the Center for Medicare, expresses optimism, “We are encouraged and inspired by six consecutive years of savings and high-quality care, with 2022 being one of the strongest years of performance to date.”

That said, the impending potential removal of the 5% MACRA incentive, which has been instrumental in the shift toward value-based care, poses significant risks. The loss of this incentive could jeopardize patient care access, lead to an exodus of specialists from APMs, and encourage consolidation in healthcare markets.

To keep value-based care on a track to success, policymakers and stakeholders must collaborate to ensure continuity and enhancement of the resources, technologies and incentives that have made this journey possible.

In this transformative journey, partnerships with organizations like MedeAnalytics are invaluable. By harnessing the power of data and analytics, we aren’t just optimizing financial outcomes; we are building a healthcare system that champions quality, efficiency, and the well-being of every patient.