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AHIP: No matter the political landscape, value-based care will continue

Reimbursement has not caught up to technology innovations, expert says.

Susan Morse, Senior Editor

AHIP CEO Marilyn Tavenner and Anthem CEO Joe Swedish, in Austin.AHIP CEO Marilyn Tavenner and Anthem CEO Joe Swedish, in Austin.

The experts agree value-based care will continue, no matter the political landscape.

"I think the key system of health transformation will continue," said Patrick Conway, MD, deputy administrator for Innovation and Quality for the Centers for Medicare and Medicaid Services and director for the Center for Medicare and Medicaid Innovation.

Also continuing, according to Conway, is CMMI, which has 26 major payment models. The election of President Trump brought speculation that Congress would do away with CMMI because it initiated models without first gaining Congressional funding approval.

"None of the legislation on the Hill changes the Innovation Center," Conway said during America's Health Insurance Plans Institute & Expo in Austin, Texas. "We're seeing a shift towards alternate payment models across the private and public sector."

A major influencer in payment reform, Anthem President and CEO Joe Swedish, said Anthem is making bets it will get a return on investment in payment models such as the insurer's 160-plus accountable care organizations.

Data shows the ACOs have seen 6 percent fewer inpatient admissions, he said.

[Also: Lack of CSRs one reason Anthem BCBS to leave ACA market in Ohio]

In Medicare Advantage, Anthem made an effort to boost quality so that now half of the enrollees, 50 percent, reside in four-star plans. The year before that statistic was 22 percent, Swedish said.

"We're now paying 58 percent of reimbursements through value-based models," Swedish said.

All of these efforts have as their goal better quality of care while reining in cost.

Economist Michael Chernew, Ph.D., a Leonard D. Schaeffer Professor of Healthcare Policy, threw some cold water on just how much - or how little - money is saved from these models.

Episode models save about 4 percent per episode, Chernew said.

Population-based payments save 1-2 percent before the bonuses are paid out. Typically, performance improves over time. One system saved up to 10 percent after four years, according to Chernew.

There's also nothing to back up ideas about wellness and the power of patients driving the system.

"Being healthy is not going to control healthcare spending growth in any meaningful way," Chernew said.

Also, he said, "Just telling people what it costs has not saved a lot of money."

[Also: AHIP conference to spotlight future of health coverage]

This is because price transparency tools are not harmonized with the benefit plan. If consumers have met their deductible, it doesn't matter whether they go to the most expensive or least expensive place.

Progress to value is slow because of operational difficulties with IT, risk adjustment and other factors, he said.

There are also weak incentives for providers, who see the change as a lot of effort for a small amount of ROI.

"We're changing the business model of delivery," Chernew said. "It's hard to change behavior. Our challenge is to move off into the unknown." 

What is known is there's a 2.1 percent gap between healthcare spending growth and national spending growth that policy-makers believe must be addressed.

The nation can't tax its way out of spending growth, Chernow said.

"It has to come back to the delivery system, payment reform," he said.

Former Utah Gov. Mike Leavitt, who was secretary of HHS during the administration of President George W. Bush, said policy choices must be made to bring down the cost of healthcare.

But Leavitt also agreed that politics will not change the momentum from fee-for-service to value.

Technology has made significant gains that can make treatment - and the total cost of healthcare - less expensive, but reimbursement hasn't yet caught up to it, according to Eric Topol, MD, the author of "The Patient Will See You Now" and director of Scripps Translational Science Institute.

Patients can take cardiograms, their blood pressure, heart rate, glucose and other levels, wearing a wristwatch.

Using a smartphone, a physician can see a person's heart, but because they can't get paid for this, it's not mainstream.

Topol himself did a full body medical selfie.

"This whole idea of the power of a human being, an individual by having their data, this is really a big turning point," Topol said. "This is setting up the growth of telemedicine. Today a video chat, tomorrow we will be transferring data. We predict virtual visits will exceed those of the physical visits."

There's also the potential to create knowledge banks. Instead of Facebook, Medbook, Topol said.

At the end of his session at AHIP, Chernew said the difference between himself and providers and payers is that he gets to look back at what's worked in the new payment models and what hasn't, while those managing systems must look forward.

Swedish said something similar during his own keynote.

"Everyday, I'm just making bets," Swedish said. "Everyday I'm having to pivot."


Twitter: @SusanJMorse

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