Value-based care improving health care and costs

By Jean Robillard / Guest Column

As we enter the new year, there are still many questions about how the outcome of the recent election could change health care laws and policies.

While we don’t yet know details, there is a significant degree of speculation about the broad policy areas where changes are most likely to occur. This includes the potential repeal and replacement of at least parts of the Affordable Care Act (ACA), commonly called Obamacare, especially as it relates to both individual and employer mandates for health insurance coverage.

While some mandates of the ACA may change, others, such as population health management and value-based payment models, enjoy broad-based support and are likely to continue and possibly even accelerate.

Health systems like University of Iowa Health Care, health insurance companies and health care providers have embraced different types of value-based payment models, including accountable care organizations and bundled payment models.

As a group, employers are especially appreciative of value-based payment models, said health benefits writer Michael Taylor. In a Benefits News article, he noted, “Not long ago, a discussion like this would have involved a fair amount of veiled finger-pointing: employers would complain about high insurance costs, health plans would vent about ever-increasing provider costs and providers would say they weren’t getting paid enough.” However, now, he said, “The groups are much more unified because of the shared experience of running their businesses in an environment where payment is linked directly to outcomes.”

Before value-based care programs, most providers and health systems were reimbursed based on volume (number of tests, procedures and patients), rather than the quality of patient care and health outcomes. Most of the financial risk in providing health care benefits was borne by insurance companies and employers. Today, providers and health care systems are sharing in that financial risk.

While progress has been slower than some would like, there is evidence that value-based care is having a positive impact on health care costs by reducing clinical inefficiency and duplication of services.

The Health Care Transformation Task Force, a group of influential health care industry executives, in December made public a letter it sent to the new federal administration advocating that the policymakers keep and prioritize value-based care models. In the letter, the 43-member group reminded the incoming administration that the movement toward value-based care has always been bipartisan and called for it to continue.

Speaking on behalf of employers, David Lansky, CEO of the Pacific Business Group on Health, noted that employers are concerned that not moving forward with value-based models would lead to higher, unsustainable costs and sicker employees, writing, “Competitiveness depends on control of healthcare costs and healthy workers.”

In addition, a recent survey of 600 U.S. employers with more than 1,000 employees each demonstrated a high level of interest and support for value-based health care by employers nationwide. As reported in Modern Healthcare magazine, the survey showed that more employers are setting up value-based reimbursement and payment arrangements with health insurers and providers.

The survey also noted that more employers are recognizing the health benefits to their employees and cost benefit to their companies of steering employees to “centers of excellence.” These centers, including those at University of Iowa Hospitals and Clinics for care in specialty areas such as cardiac or orthopedic services and infertility treatment, are so designated because of their high-quality ratings. In 2016, 45 percent of employers gave employees access to centers of excellence, up from 37 percent of employers in 2015.

Recognition that value-based care is an effective way to advance high quality health care services, improve the health status of patients and communities and help reduce the rising cost of health care is encouraging. By continuing to work together, I believe that we can positively influence the coming transformation in health care for Iowa and beyond.

Jean Robillard, M.D., is vice president for medical affairs and dean of the UI Carver College of Medicine at the University of Iowa.