5 Emerging Trends in Value-Based Care

Feb 25, 2021 | Uncategorized

5 Emerging Trends in Value-Based CareThere are 5 emerging trends in value-based care for 2021. The practice of value-based care has picked up momentum because of the pandemic and pressure has been put on healthcare providers to stay up-to-date with trends. Continue reading below to learn more about the 5 emerging trends in value-based care this year.nnThe pace and pressure to embrace value-based care are picking up. The COVID-19 pandemic exposed the risks and limitations of reliance on fee-for-service reimbursement and, combined with the groundbreaking changes in health care delivery models and regulatory flexibility, indicate a renewed focus on value-based care. This article outlines five of the top trends to watch for in value-based care for 2021.nn1. Leaning Into Value-Based CarenOne of the lessons from 2020 is that reliance on fee-for-service can leave providers vulnerable to volatility and changes in demand. As utilization plummeted during the COVID-19 pandemic, providers who had invested heavily in value-based care have been better able to weather the pandemic and the economic downturn by having a consistent source of revenue despite low utilization. The rapid changes in health care driven by the pandemic only further emphasized the need for providers to lean into value-based care. Beyond the allure of steady revenue streams, new regulatory flexibilities and care delivery innovation creates an opportunity for providers to realize a more rapid rate of return on their investment in value-based care by increasing the portion of their business with value-based care reimbursement.nn2. Continued Innovation and DisruptionnWhile value-based care has always been an area ripe for innovation, 2021 presents a unique set of circumstances that point to a surge of innovation and disruption in both payment and care delivery models. Value-based care had been a priority for the Centers for Medicare and Medicaid Services (“CMS”) under the Trump administration, but there is no reason to expect a change of course away from value-based care. In fact, the Biden administration’s health care goals will likely require an increased emphasis on cost savings, which may result in an even greater push towards value-based care. Some news outlets are reporting that Elizabeth Fowler is a front-runner to lead the Center for Medicare and Medicaid Innovation, further signaling that CMS’s momentum on value-based care will continue. Commercial payors also continue to push towards innovative payment and care models as COVID-19 has highlighted the inequities in the healthcare delivery system and challenges for providers.nn3. Capitalizing on COVID-19 InfrastructurenThe COVID-19 pandemic prompted transformational changes to the health care system that portend continued opportunities to manage patient care and provide quality care in lower cost settings. As a result of the pandemic, both the federal and state governments threw open the doors to allow providers to furnish services via telemedicine and other digital health modalities during the COVID-19 public health emergency. Many of the telehealth waivers have been made permanent. Providers who have embraced digital health as a way to weather the pandemic will also have the opportunity to capitalize on this investment as a way to manage patient care and see a return on investment for services that are typically not reimbursable under fee-for-service arrangements. CMS also created the Hospital Without Walls and Acute Hospital Care at Home programs to increase hospital capacity during the pandemic. Commercial payors have been eager to seize on these opportunities to promote lower-cost services. Providers who have invested in these types of programs similarly provide an opportunity to provide quality care in lower cost environments, which will benefit providers who are fully engaged in value-based care.nn4. New Opportunities for Provider AlignmentnRecent changes to federal law aim to lower barriers to value-based care. In particular, CMS and the Office of Inspector General (“OIG”) created new flexibility under the Stark law and Anti-kickback Statute for value-based arrangements to allow providers to enter into value-based care arrangements that previously may have been prohibited. While the new exceptions and safe harbors still require that arrangements be carefully crafted, they provide new opportunities to align with providers and to incentivize activities that promote value-based goals that were previously unavailable. Additionally, the sweeping interoperability and information blocking rules aim to ensure that patients and providers are able to access health information, further reducing structural barriers to value-based care.nn5. Emphasis on Social Determinants of HealthnFinally, players in the value-based care space—particularly in Medicaid managed care programs—are placing greater emphasis on addressing social determinants of health. Providers and payors are beginning to recognize the crucial role that non-medical factors play in patient health. By solving for these issues—such as transportation, food, housing, language services, etc.—providers and payors are able to realize significant benefits in improving patient health and outcomes while keeping medical costs relatively low. The focus on social determinants of health is an emerging trend in value-based care that is likely to grow as players seek creative ways to manage patient care through value-based arrangements.nnAs providers and payors emerge from the upheaval of the pandemic and the resulting revolutionary changes in health care, we can expect renewed interest in value-based care. Opportunities abound to capitalize on the changes wrought by the pandemic, as well as emerging prospects, by fully investing in value-based care.nnOriginal article published on natlawreview.com