Top 5 Value-Based Takeaways of the Past Year

The value-based care push is one of the most important trends in American healthcare, and it is always evolving. Here are 5 important takeaways from Healthcare Analytics News™'s coverage on the topic in 2017.

The New CMS is Not Going to Force Hospitals Into It

Many of the changes in today’s healthcare industry—like the rapid adoption of electronic health records (EHR)—were spurred by government incentives. Value-based care seems to be going down the same route: While the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) still barrels down on health systems, the Centers for Medicare and Medicaid Services (CMS) has backed off of smaller initiatives.

In early December, CMS issued a final rule that cancelled some proposed bundled payments for orthopedic and cardiac interventions. The Episode Payment Models were first announced late in the Obama administration. CMS Administrator Seema Verma said that the agency “continues to believe that bundled payment models offer opportunities to improve quality and care coordination while lowering spending,” but that it prefers to pursue them on a voluntary basis going forward.

“Exnovation” Can Be a Good Thing

“Innovation this, innovation that,” healthcare professionals hear about “innovation” constantly. A binary concept, “exnovation,” is pretty foreign, though. To achieve value-based care, it might be important for physicians to consider the term.

To make room for newer, better procedures, researchers behind a recent report expressed the importance of scaling back procedures that provide little benefit to patients. They contrast that with “de-adoption,” or the total abandonment of use.

“In the US, we're not doing a good job of cleaning out the closet of those moth-eaten sweaters, so to speak,” Dartmouth Institute health economist and study co-author Jonathan Skinner, PhD, said of the findings. “We need to do a better job to ensure that there's plenty of fiscal space for the new and valuable innovations appearing in the coming years."

Watson is Getting in On It

Why not, right? Not long after the dawn of 2017, IBM CEO Ginny Rometty announced a program that would integrate Watson’s artificial intelligence powers with data stored in electronic health records (EHRs) to make value-based predictions.

"This idea of cognitive healthcare, systems that learn, this is real and it is mainstream and it is here and it can change almost everything about healthcare," said Rometty during her talk. The new value-based system, which is completely cloud based, gives providers and insurers the ability to identify potential risk factors and flags to prevent events at a population, group, or individual basis.

That said…

The Use of Analytics to Achieve It is Uneven

Predictive analytics technologies can be hugely helpful in developing value-based care programs. A computer can find inefficiencies in huge sets of data that the human mind could not possibly pinpoint. Still, there are plenty of hospitals that can’t afford to use such technologies.

In a major academic institution, it may be possible to employ a strong analytics team, “but in a run-of-the-mill hospital that’s a science fiction scenario,” Marco D. Huesch, MBBS, PhD, Penn State University's Milton S. Hershey Medical Center, said. “I think it’s important to be fair to some hospitals where it may legitimately be a bridge too far.”

An Ernst & Young survey highlighted the gap in commitment to value-based models. Their 2017 Health Advisory Survey of 700 medical executives found that 67% of the smallest health systems (revenues of $100 million to $499 million) and 61% of the next group (revenues of $500 million to $999 million) had no value-based reimbursement initiatives planned as they entered 2017. By contrast, 92% of the largest health systems (revenues of $5 billion or more) did have such initiatives for 2017. Only 26% of respondents placed analytic insights and new technologies among their top 3 priorities for the year.

Thinking Must Change Before Practice Can

Healthcare, particularly American healthcare, is an extremely unique industry. The concept of value-based care flies in the face of how many physicians and health system administrators learned to navigate the industry.

“If we put our heads in the sand and make believe that money doesn’t matter, we’re idiots,” Michael Kolodziej, MD, the Chief Innovation Officer at ADVI Health, declared in a speech at the Patient-Centered Oncology Care meeting in Philadelphia. “We are going to have to make some hard choices.”

With MACRA on its way, it’s essential, he said, that doctors begin to think differently now. He made a comparison to the automobile industry: there was a time when high gas prices dominated headlines just as expensive healthcare premiums do today. General Motors stopped making Hummers, he said, but oncologists are still selling highly inefficient care decisions.