Value-based care continues to take root in healthcare. It's clear the future of reimbursement will at minimum include a heaping portion of providers being paid for value as opposed to volume.

This is why, as the new year approaches, Healthcare IT News sat down with an expert in value-based care to get his views on what 2022 will hold for the payment system.

Caravan Health President and CEO Tim Gronniger previously was chief of staff and director of delivery system reform at the Centers for Medicare and Medicaid Services. Caravan Health is a privately held company formed to create sustainable methodologies for health systems to excel in value-based care. In 2019 and 2020, its partners earned $300 million in Medicare savings, more than $120 million in shared savings and quality scores exceeding 97%, the company reported.

Gronniger eyes four areas of importance for value-based care in 2022: telemedicine, staff retention and provider burnout, health equity, and growth in value-based payment.

Q. Health providers quickly pivoted to make the most of temporary telehealth flexibilities when the COVID-19 public health emergency (PHE) started in 2020. While Congress and CMS have considered permanently expanding access to telehealth and virtual care, there is a big price tag attached. What do you think will happen with telemedicine in 2022?

A. Telehealth has made a huge difference in delivering appropriate care to patients since the beginning of the pandemic. The COVID-19 public health emergency – and its expanded telehealth flexibilities – is continuing at least through the beginning of 2022. We hope to see some movement on a permanent telehealth arrangement before the PHE ends.

Before the pandemic, telehealth services in fee-for-service Medicare were restricted mostly to rural areas in which patients would travel to a healthcare facility, called an originating site, to receive care from a provider who also was in a healthcare facility, called a distant site.

Even in rural areas, making use of these pre-PHE authorities was not easy. Patients usually had to travel to their doctors' offices, and offices had to own and maintain video and audio technology.

An abrupt end to telehealth would create access issues for patients who have grown used to accessing high-quality care more conveniently. Providers have invested in equipment and services to provide this important source of care, and those investments should not be abandoned.

CMS has taken regulatory action to increase the availability of telehealth. As Congress considers which elements of the current regime to extend, it should prioritize telehealth within accountable care and other value-based care arrangements, where physicians can select the most appropriate, high-value modality for care delivery.

Sometimes, that will be in-person, sometimes remote, but in either case, providers in accountable care arrangements internalize those costs. There are cost controls built into these programs, so telehealth can't increase overall costs.

By linking telehealth reimbursement to value-based care, patients have access to telehealth services because it is the most appropriate care for the situation, not because it is more profitable than in-person care.

Q. The growing demands on clinical staff have led to staff burnout that threatens health access. You say that population health and team-based care can be effective approaches to retaining staff and improving clinician satisfaction. These retention concerns are heightened with the introduction of vaccine mandates. What can healthcare provider organizations do in 2022 to fight burnout and retain staff?

A. Healthcare organizations have to pay close attention to clinical and non-clinical staff satisfaction.

Team-based care means that patients are at the center of care delivery. For years, we have talked about the importance of the triple aim of advancing quality of care, reducing costs and improving the patient experience. In 2022 and beyond, we need to make sure that clinical satisfaction and retention is not overlooked.

This is an important issue in light of widespread concern about physician burnout. We have to have an honest discussion with our teams about the trauma that they have experienced as we come to the end of the second full year of the pandemic.

We have to provide providers with resources including counseling and even just giving them time to recover. That's not easy while staffing is still stretched, but it's important.

The federal vaccine mandates are not too old, but many providers have been working hard on complying with state, local or individual health system mandates for months. Even with new requirements, the approach to retaining staff should stay the same: create a system of care delivery that works for everyone.

Engaging the entire team in a proactive primary care system is the key to spreading out the work and placing resources where they can do the most good.

Q. The racial, ethnic and income-based health disparities in the U.S. are persistent and not easily fixed. You contend that traditional fee-for-service medicine pays providers for the volume of service delivered and does not appropriately compensate providers for promoting health and preventing acute illness or development of chronic conditions. How can value-based care help out in 2022 and beyond?

A. Traditional fee-for-service pays for services delivered to patients. The more services provided, the more the provider is reimbursed. The incentives are to treat sickness, rather than paying providers to keep people well and out of the hospital. We have to turn this model around to get the best outcomes.

In a value-based care model, providers have the incentives to create population health-focused care delivery and save money while keeping beneficiaries well. The incentives of a value-based care model can be useful in addressing our country's stubborn health disparities. Metrics related to social determinants of health and reducing health disparities can be incorporated and refined within these models.

Our clients today are focusing their energies on serving their sickest patients. I fully expect and embrace that CMS and other payers will soon hold us accountable for improving clinical outcomes for minority populations, and we are ready for that.

For providers in value-based payment, assessing health needs of different populations and addressing the social factors that impact health are not driving up costs, they are aligned with the incentives of whole person care that ultimately saves money.

Q. CMS recently announced a goal of serving all Medicare beneficiaries through accountable care or other total cost of care arrangements by 2030. You believe this goal is a step in the right direction for our healthcare system that has too often paid based on volume rather than value. However, CMS can't do it alone. What are some ways accountable care organization (ACO) management and other organizations are helping guide providers through value-based payment?

A. The most encouraging part of the Center for Medicare and Medicaid Innovation's (CMMI's) goal of expanding total cost of care arrangements is the explicit link to achieving equitable outcomes for patients.

CMMI leadership is keeping its focus on the outcome of broad health system transformation. ACO management organizations are in touch with these providers every day and know the specific concerns or barriers to entry. Companies that specialize in building and managing ACOs have proven they can get all kinds of providers into accountable care with strong quality and financial results.

This goal of increasing participation in accountable care is shared by other important value-based care stakeholders.

MedPAC recently considered innovative ideas to change benchmarking for ACOs to be more attractive and realistic for participants. Benchmarks are the key to earning shared savings – an important marker of success for any ACO participant. CMS also is raising fundamental questions about making benchmarks more fair and more predictable.

It is possible we will see policy changes that appear to be technical changes to benchmarking but are critical to getting more participants in sustainable value-based care relationships. These might include fixing the "rural glitch" or addressing the HCC risk score cap. Both of these were discussed but not ultimately finalized in the 2022 Medicare Physician Fee Schedule.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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