The American Heart Association (AHA) is advocating for the shift away from fee-for-service to a value-based payment system. The value-based model, they say, is “person-centered, equitable, coordinated and seeks to improve outcomes and experiences for patients and clinicians,” while also better managing the costs of service.
The traditional fee-for-service framework pays clinicians by the number of services they provide, but not by the quality of care the patient receives or the outcomes they experience. In a Monday release, the AHA emphasized that a shift to value-based payment represents a renewed focus on both quality of care and patient outcomes.
“Value-based care delivery and payment models hold the promise of producing better patient outcomes and lowering costs,” said Karen E. Joynt Maddox, MD, a member of the American Heart Association’s Advocacy Coordinating Committee. “Value-based programs represent an important but under-recognized opportunity to improve the clinician’s experience and the efficiency, quality and value of patient care.”
With Medicare Advantage covering more than half of Medicare beneficiaries, the growth of value-based care has become impossible for providers to ignore. The Centers for Medicare & Medicaid Services also has set a goal of 2030 for those on Medicare and MA to be treated under value-based care agreements.
For a transition that focuses on health equity for beneficiaries, the AHA makes a number of recommendations. The association urges insurers to consider including social determinants of health in risk adjustments, make sure caregivers have the resources necessary to best treat patients, use the flexibility of funding to promote comprehensive care, and make sure value-based care payment is aligned across public and private payers.
The result, they hope, will achieve health equity for all payers. Advancement of health equity, AHA states, is key to improving the quality of care, and so each value-based care program should include measures to promote equity for beneficiaries.
In the balance between reducing cost and improving quality of care, AHA recommends prioritizing quality. A person-centered approach, the association said, is the best route to ensuring health equity for all patients.
