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Healthcare Priorities for the Next Congress: Advancing the Transition to Value-based Payment in Healthcare

Healthcare Priorities for the Next Congress

Center for Healthcare Regulatory Insight Forum


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On December 7, the Center for Healthcare Regulatory Insight hosted its third thought leadership forum on healthcare priorities for the next Congress and advancing the transition to value-based healthcare payments.

  • Growing bipartisan consensus on concerns about healthcare cost drivers and access, and the need for bipartisan efforts to identify permanent, solution-oriented reforms
  • The need to also simplify the current tax code, which is inexplicably linked to healthcare.
  • Republican leadership efforts to address the shortcomings of the ACA and create an environment for payments models that create strong incentives for change, which may include the continuation of CMMI or other vehicles to spur innovation
  • Continued consensus and support for MACRA, while also recognizing that implementation has been, and will continue to be, complicated.

A distinguished panel followed to discuss insights about the transition to value-based models, includingregulatory, tax, legal, and operational barriers to this shift. For example, the Stark Law and Anti-Kickback Statute carry implications for integrated care delivery due to restrictions to referrals and limits to innovation. Although CMMI has offered some waivers of these restrictions to organizations that have implemented clinically integrated value-based delivery models, the waivers, as well as other elements of the Affordable Care Act (ACA), are at risk under the proposed ACA repeal and replace process.

Other challenges for providers and payers include lack of readiness capabilities, limited infrastructure, and reluctance to incorporate risk-based care delivery models in times of regulatory uncertainty and potential negative impacts to profit margin. Lack of operational and clinical alignment between providers continues to be a barrier to effective care coordination; while variability across multiple commercial and federal payers, including on quality measurement, patient attribution, and data sharing, has slowed the adoption of multiple payment models. More education is needed for both individual and large group providers about regulatory compliance and practice requirements, particularly for MACRA in the coming years. Finally, providers need better communication tools and cost of care data to more effectively transform care and improve patient outcomes.

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