Physician Leaders to Policymakers: “Keep up the momentum on value-based payment.”

The doctors of the Council of Accountable Physician Practices (CAPP) want policymakers to know that now is not the time to pull back from health care payment models that reward value over volume. In “Moving the Needle on Value-Based Payment,” the final paper in CAPP’s three-part series, Implementing Health System Improvement, CAPP members acknowledge that there have been some challenges in adopting value-based payment (VBP). Nevertheless, they say, it is imperative that we address those challenges and continue to move forward, rather than slowing the pace of the endeavor — as a CMS spokesperson recently said the agency intends to do (P. Cunningham, Washington Post, February 20, 2018).

In the report, the physician leaders reiterate that the dominant fee-for-service payment system rewards providers for producing more care — whether that care contributes to health or not. They then describe the benefits CAPP groups and their patients have realized from participating in VBP initiatives under Medicare, Medicaid and private payers.

“All of the large, integrated, multispecialty health systems that are members of CAPP earn some degree of VBP — and all of us would like to earn more” says Stephen Parodi, M.D. chair of CAPP. “Whether through primary care medical homes, bundled payments, ACOs, or even capitation (such as Medicare Advantage), these payment systems hold us accountable for improving people’s health, not simply doing more procedures. That really allows us to achieve true innovative solutions for delivering care that’s coordinated, cutting edge, convenient, and most importantly, producing ever better health outcomes.”

In fact, the report explains, one of the most important outcomes of the VBP movement is that it has encouraged a fundamental shift in the way doctors think, allowing them to focus on the “total cost of care” — a data-driven concept that encompasses both the volume and the unit costs of services across the entire spectrum of care.

VBP lets us step back and look at patterns of care over time, so we can change our processes to improve quality and efficiency.

—Dr. Stephen Parodi, Executive Vice President of the Permanente Federation

Dr. Parodi adds, “VBP lets us step back and look at patterns of care over time, so we can change our processes to improve quality and efficiency. Are we performing unnecessary or redundant imaging or lab tests? Are we missing opportunities to help our patients get preventive care by not being open late or on the weekends? Are we noticing that patients aren’t following through on self-care at home because they need more support from us? Under VBP, we can tackle all of these types of issues, without worrying whether the ‘fix’ is one that will drive revenue.”

To ensure more effective implementation of VBP, the CAPP leaders call on policymakers to work with stakeholders to align bundled payment models; to continue to address technical challenges in the ACO program; and to focus on two-sided risk models (including Medicare Advantage), which provide greater incentive and more resources to invest in innovation. Most critically, the group urges the administration not to slow down, commending its commitment to VBP to date because, they say, those models “give providers a glide path of steps they can take to change the way they deliver care.” They also express serious concern over signs that the administration may pull back from VBP, noting that such decisions “move value-based payment and care redesign in the wrong direction.”

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