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Undergraduate | Nov 23, 2021 |

GHIMC Fall Forum Tackles Value-Based Care with Star-Studded Panel

By Eliana Chow

On November 18, Fordham’s Global Healthcare Innovation Management Center (GHIMC) hosted a groundbreaking virtual conference entitled “Value-Based Care and Value-Based Payments: Innovating for Now and the Future.” The high-profile event brought together healthcare leaders from the federal government, private payer, and private provider sectors for a conversation that addressed the challenges of transforming the U.S. healthcare system from a volume-based to value-based model over the next 10 years.

Setting the Stage

Politicians, academics, and practitioners have hotly debated value-based care for decades, but the COVID-19 pandemic pushed the topic to the foreground.

“From burnout among healthcare workers to increasingly expensive care, the pandemic has brought into stark relief many of the issues the U.S. healthcare system has faced for generations,” said Dr. James Couch, interim director of Fordham’s MS in Health Administration and Fellow of the GHIMC. “The adverse effects of primary care’s decline have never been more apparent.”

Under the fee-for-service (FFS) model, which has defined healthcare payment systems in the U.S. for more than 75 years, physicians and other healthcare practitioners are compensated based on how many patients they treat (volume) rather than the quality of the care they provide (value). For decades, stakeholders have held that FFS has the greatest chance to improve quality of care, by permitting physicians to order what they see fit for patients.

But throughout this event, Dr. Couch and his colleagues suggested the opposite may well be true: In the long-term, FFS may well hurt the quality and certainly the value of care by making clinical decision making less grounded on the best scientific evidence of what type and amount of care is most appropriate for patients.

Applying this more scientific approach to clinical decision-making may also save tremendous amounts of money by decreasing wasteful and potentially unsafe care, while improving those clinical outcomes most important to patients. By decreasing costs and minimizing the hassle associated with unnecessary care, this will improve greatly patients’ overall experience with the care process and dramatically lower the chances of medical liability even when the results of care may be less than optimal.

6 Cs for Healthcare Innovation

To set the stage for the discussion to follow, Dr. Couch, who has spearheaded breakthrough, value-based care research and initiatives for the past 40 years, introduced six key considerations that should inform healthcare innovation.

• Commonwealth fund comparisons and causes of poor value—Why does the U.S. rank last in healthcare access, efficiency, equity, and patient outcomes?

• Common cause of poor performance—The FFS model reinforces volume over value, leading to higher costs for patients and often ineffective care from practitioners.

• COVID-19 crisis among caregivers—The FFS model also has contributed to unprecedented levels of healthcare worker burnout and loss of income from cancellation of elective FFS-reimbursed elective procedures

• Coordination of Change in payment and delivery systems—Healthcare groups have to prepare for and coordinate change by measuring and continuously improving superior value care most associated with the outcomes of greatest importance to patients

• Consequences for caregivers and their patients—Value based care produces more predictable costs for patients and payers and revenue for providers leading to more consistent healthcare outcomes

• Consensus and collaboration among stakeholders—Cooperation through achieving consensus among all stakeholders (purchasers, payers, providers, pharma, policymakers & patients—the “6 Ps”) to permit effective collaboration is key to successfully implement value-based care.

The Road to Real Change

Dr. Elizabeth Fowler, director of the Center for Medicare and Medicaid Innovation (CMMI) within the U.S. Department of Health and Human Services, opened the event’s main session by unveiling CMMI’s 10-year strategic plan for transitioning the U.S. healthcare system to value-based care. CMMI will target five overarching objectives as it develops “a health system that achieves equitable outcomes for through high-quality, affordable, person-centered care,” she said.

• Drive Accountable Care
• Advance Health Equity
• Support Care Innovations
• Improve Access by Addressing Affordability
• Partner to Achieve Health System Transformation

To underscore the importance of strategic planning, Dr. Michael Dowling, CEO of Northwell Health, discussed how sustainable change takes time. Rather than trying to accomplish too many objectives within a condensed timeline and limited budget, he urged investors to be willing to spend more dollars up front for long-term, thoughtful innovations that will generate a lasting impact. Dowling also hopes that top officials and industry experts will take time to communicate well with stakeholders.

“What do we mean by value?” he asked. “How do we define population health? Rather than getting addicted to labels, we need to define, in central language, what we actually mean.”

Echoing the need for accessible language, Karen Ignagni, president and CEO of EmblemHealth and a major player in bringing the Obama administration’s healthcare initiatives to fruition, revealed a telling statistic from an EmblemHealth survey of the general population: Only one in four individuals has encountered the term “value-based care,” and only one in four of those can explain what it means. EmblemHealth, one of the largest, non-profit healthcare networks in the country, is committed to bridging the gap by partnering with local health and wellness organizations and practices to bring accessible, affordable care to underserved communities.

“Value-based care is not just about reimbursement,” said Ignagni. “It’s about changing the entire dynamic of the healthcare system.”

Collaborative Conversation

To close the conference, Dr. Couch and Falguni Sen, PhD, director of the GHIMC, moderated a brief audience Q&A session featuring Ignagni, Dr. Fowler, and Dr. Gerry Brogan, senior vice president and chief revenue officer at Northwell Health. Throughout the session, they unpacked topics like incentives to promote more value-driven clinical decision making, transparency, how to minimize medical liability while transitioning to value-based care through Value Based Risk Management practices, prioritizing reform, and the cost-efficient development and use of new medical technologies.

“Our society tends to talk over one another in dialogues of change, emphasizing our differences rather than our similarities,” Dr. Couch concluded. “This edition of the GHIMC Fall Forum exemplified collaborative conversation and problem-solving, opening the door to a wealth of possibilities for the future of healthcare in America.”

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