We’ve spent a lot of time discussing healthcare these days – even more than usual, that is. And it’s no wonder. Our world has been upended. Serology testing, viral load, and reagent have become common, everyday terms.
However, for those of us who have led the transition to value-based care, we have been contemplating different terms, like catastrophic loss, unforeseen circumstances, and downside risk.
The advanced payment models that define value-based care call for providers and payers to have “skin in the game.” If we can deliver care for less than historical benchmarks – while demonstrating high quality and better health outcomes – then we share in the financial savings. If we spend more delivering that care, we’re on the hook for the extra cost.
But how does this all work during a pandemic, when so many of the patients whose healthcare we manage have required hospitalization and long recoveries, including rehabilitation? The current circumstances have those of us in the value-based care “trenches” scratching our heads wondering, “Who will shoulder these catastrophic costs?”
Taking Stock In addition to the obvious increases in hospital-related care, the pandemic also affects patients who have thus far been untouched by the virus itself. Yet COVID-19 still threatens their health.
Afraid of infection, healthy patients may postpone or cancel wellness visits. Patients with chronic disease may fail to adhere to medication regimens or disease monitoring. And most frightening, non-COVID patients with acute illness or a health crisis, like a heart attack or stroke, may skip a lifesaving trip to the emergency department.
All of this has the potential to degrade the overall health status of the patient populations we serve. Patients may be sicker overall, which translates to higher costs for our organizations. Moreover, without decisive changes from CMS and other payers, the move towards value-based care may slow or stop altogether.
On The Bright Side
There are positives, even in challenging times like these. For example, we’ve seen members of our industry take action to protect the future of value-based care, particularly the future of ACOs. Multiple organizations, including the American Academy of Family Physicians and the National Association of ACOs, signed a joint letter to CMS requesting policy changes in March 2020. These proposed changes include extending timelines and deadlines for applications, changing 2020 reporting obligations, and adjusting downside risk for COVID-19. These changes have the potential to be a lifeline for many physician ACOs, and other provider organizations that operate under global risk contracts.
Another positive? Physicians have fortified and ramped up their telehealth services. Our teams are better trained to deliver telemedicine, and our patients are more receptive to this new platform of care – not a small feat. Plus, improved telehealth services give us a valuable tool going forward as we care for patients with chronic conditions.
In fact, a robust, effective telemedicine program can lead to healthier, more connected patient populations – something we were certainly working toward before the pandemic hit. And these programs can positively affect your entire patient population – not just the sickest ones. Keep in mind, though, effective telemedicine programs require more than capable providers. They require a patient portal that’s easy to navigate, and they require proactive efforts to convert in-person visits to telehealth appointments.
In addition to this forced move toward technology, we also expect the pandemic to make our patients more sensitive to the merits of hygiene and social distancing. Such behaviors can reduce the incidence of communicable diseases. We’ll also likely see more patients vaccinated for flu and pneumonia. And we anticipate fewer unnecessary ER visits. Looking Ahead
We fully expect to see CMS address the current circumstances and expand the language that protects providers from unforeseen disasters. We’re also likely to see changes to CMS reporting requirements that recognize the labor shortages created by the pandemic. If these changes take shape, particularly if ACO losses are forgiven this year, providers who have embraced value-based care may stay the course.
No matter what the future holds, we all know what we have to do in the moment – provide care for our patients and support for our caregivers for the heroic work they’re doing.
For more information about Genuine Health Group, a Miami ACO, contact the Growth and Retention Department at firstname.lastname@example.org. For additional information on quality and benchmarks, download Genuine Health’s white paper, “Five Strategies to Improve Quality Measures.”
Joe Caruncho has earned a national reputation for his pioneering work in advancing value-based care and helping physicians transition to this new model of care delivery. Prior to serving as CEO of Genuine Health Group, Joe co-founded Preferred Care Partners, a Medicare Advantage plan, which he and his partners sold to United Healthcare. As Preferred’s chief executive, he helped grow membership to 55,000 and generate sales in excess of $750 million.
For more than a dozen years, he practiced corporate healthcare law, representing physicians, hospital systems, health care delivery networks, ancillary providers and health plans.