Value-based care on a state level

The shift to value-based care from the fee-for-service model has focused on the Centers for Medicare & Medicaid Services (CMS), on the federal level. However, many states have value-based programs for medical providers as well. A recent study found that a number of states have “created value-based programs to work with healthcare stakeholders to redesign the healthcare system.”

These state initiatives are relatively recent, according to the study:

  • 6 states launched valued-based payment programs four or more years ago
  • 23 states started their programs two or more years ago
  • 10 states are still in the early stages of rollout

In addition, the study found that:

  • 17 states adopted or are considering creating accountable care organizations (ACOs) or similar entities to manage cost and deliver better care.
  • 12 states adopted or are considering episodes of care programs.
  • 23 states created value-based payment targets or mandates, which payers and provider must achieve.

Value-based care focuses on the quality of the healthcare provided to patients, rather than the number of patient visits. Independent physicians are reimbursed based on quality measures established by CMS. They also face the challenge and the burden of a significant number of regulations and reporting requirements as a result of the move to value-based reimbursement.

Dr. Jason Spangler, executive director of value, quality, and medical policy at Amgen, addressed the News & World Report’s Healthcare of Tomorrow conference recently, indicating that value-based care should shift to the patient to some extent.  ““We should pay and incentivize patients toward high-value care and disincentivize them against low-value care.”

CMS has recognized the burden that independent physicians face and has taken steps to alleviate some of the paperwork involved. Many in the healthcare field believe that additional steps must be taken, beyond the federal initiatives. Partnerships between healthcare payers and providers could involve ACOs similar to those adopted or considered by 17 states as well as additional patient-centered medical homes, to improve the quality of healthcare and to further emphasize and reward value-based care.