What is going on with Value-based payment models in healthcare? We’ve been talking about it for years and despite all the chatter and investment, uptake has been slow. Now, the CMS Innovation Center (CMMI) has put many of its models on hold including the Direct Contracting Geo model that we covered earlier this year. Does this mean we are moving away from value-based payment models? Absolutely not! In fact, things are going to start moving much more quickly towards value in 2022.
A Nearly Universal Commitment to Value-based Payment
Let’s start with CMMI. Director Liz Fowler has been consistent in her messaging in the past six months and I would summarize her position as follows:
- We’ve made great progress in moving towards value-based payment.
- We’ve hit a bit of a lull.
- The main reason for that lull is that “it’s a bit too comfortable to sit in Fee For Service”.
- She wants to break us out of the lull.
- Mandatory models may be necessary to do that.
So, I’m hearing that we should expect mandatory models that make Fee For Service very uncomfortable. That’s a big deal and more than a signal from CMS.
Beyond CMMI, belief in value-based payment has been consistent across the past 3 presidential administrations, is popular in Congress, and is being driven forward by employers with self-funded health insurance plans. Everybody wants to see this happen and the pieces are in place for a major push in 2022.
What You Need to Know About Value-based Payment Models in 2022
The #HCBiz Show is partnering with Value-based payment expert, Gail Zahtz to bring you a 5-episode series that will get you ready for 2022. Here’s what you can expect:
Gail Zahtz summed it up this way: “The current value-based contracting has failed to realize the promise of health equity. That’s not going to occur moving forward.” If anything is clear, it’s that health equity is a priority heading into 2022. We’ll help you prioritize your efforts.
We address listener feedback that we’ve been hearing about the move to value for 10 years. We’ve invested in it through several evolutions and it still hasn’t come to fruition. The key is to rebuild trust between the government and those delivering the care- whether hospitals, payers, providers, or innovators. Otherwise, they won’t trust enough to take action.
Gail explains what doctors can expect in terms of Medicare FFS payment come January 1, 2022. We discuss this as another example of CMS trying to make Fee-for-Service less “comfy” and expedite the move to value-based payment models. Gail helps us to understand what options exist and we lay out a framework for how to evaluate those options.
The No Surprises Act intends to prevent patients from getting burned with huge, unexpected bills for medical services. Implementation (and reality) will bring new surprises.
Zahtz has been founding and running mission-driven organizations from the get-go.
Today, Gail Zahtz is the CEO of PropHealth, a value-based administrator that creates and manages healthcare collaboratives to drive clinical and financial success. Their expertise and services focus on contracting, operations and growth for clinically integrated networks, risk bearing entities, and those that fund and deliver healthcare innovation.
Her healthcare career has been guided by these truths: 1) Sustainable change will only happen when every stakeholder gets value, 2) It is good business to “do good” 3) Mission matters, 4) Business can only sustain service with profit (it’s not a necessary evil, it fuels growth), 5) It’s all about experience, 6) The true north is the patient journey – always.
Being mission-driven always has and continues to shape her career. Right out of college, Gail helped to shape health policy in Washington DC. In her first start-up, she addressed work-related health issues for employees through a cause-related marketing agency. Independently she created an award-winning program to reduce the stigma of mental illness by creating a novel public-private partnership.
On many occasions, Gail has spoken to small and large audiences and through social media platforms. She advised the industry on designing for health outcomes and won numerous awards including – Top 100 in Health Info Technology, Top 100 International Influencers in Health Online, Healthcare IT News’ #HIT100, Recipient Walking Gallery of Healthcare, and Top 50 Most Influential Health Leaders. Her public health education campaigns have also been nationally recognized including being awarded the most influential public education campaign by the National Mental Health Association.
As a survivor of late-stage cancer and of domestic violence, she is particularly inspired when sharing her stories of how to survive and thrive despite the most challenging of circumstances to show a way forward to young women everywhere.
To connect with Gail, reach out on Linked In @ https://www.linkedin.com/in/gailzahtz/
PropHealth is a value-based administrator that creates and manages healthcare collaboratives to drive clinical and financial success. Our expertise and services focus on contracting, operations, and growth for clinically integrated networks, risk-bearing entities, and those that fund and deliver healthcare innovation.
Listen to the series preview right here:
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