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A Road Map For Action On Health Care Spending And Value: Part IV – Value-Based Payment (Forbes)

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FORBES | This is the fourth and final installment for my series on the Health Affairs Council on Health Care Spending and Value’s February 2023 report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which include recommendations on how the U.S. can take a more deliberate approach to moderating health care spending growth while maximizing value. I served as co-chair of this initiative, along with former FDA Commissioner Dr. Margaret Hamburg. This final piece outlines our recommended actions on value-based payment. Click here to read Part I, Part II and Part III. 

Over the past few years, the health care sector has undergone a cultural shift toward not only prioritizing better value and more comprehensive care but also in how these services are paid for. The days of strictly fee-for-service payment models – where physicians or health centers are paid for each individual service provided – are dwindling. And value-based payment models have stepped into the fold for both public and private sectors. 

In an effort to drive down rapidly growing healthcare costs, value-based care and payment models have garnered a lot of attention for their potential to curb costs while simultaneously improving outcomes. These models come in variety of shapes and sizes, combining innovative arrangements that prioritize quality of care rather than quantity of services provided. Some examples of these models include bundled payment, accountable care organizations, and even full global capitation.  

But the emergence of value-based payment models has not come without challenges.  

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/03/10/a-road-map-for-action-on-health-care-spending-and-value-part-iv–value-based-payment/?sh=2da6363f5d7a

A Road Map For Action On Health Care Spending And Value: Part III – Spending Growth Targets (Forbes)

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FORBES | This is the third in a four-part series on the Health Affairs Council on Health Care Spending and Value’s newly released report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which provides recommendations on how the U.S. can take a more deliberate approach to moderating health care spending growth while maximizing value. Part three focuses on our recommendations on setting spending growth targets. Read parts one and two here and here.

The Health Affairs Council on Health Care Spending and Value looked to states to be laboratories for policy experimentation and innovation. One area the Council members spent time investigating, with presentations from experts over several meetings, is state efforts to set spending growth targets. Two states in particular have led in this area: Maryland and Massachusetts.

The Maryland Example

Maryland has a long-standing history of setting growth targets dating back to the 1970s when they established all-payer rate-setting for hospital payments. Enabled by a Medicare waiver, Maryland was exempted from certain federal health care regulations in exchange for ensuring that Medicare inpatient payments per admission grew at a rate below the national growth rate. The state set rates for hospital inpatient services, and all third parties paid the same rate. This effort evolved in 2014 to a global hospital budget that encompassed inpatient and outpatient hospital services. Under what became known as the Maryland All-Payer Model, the state created a prospective annual budget for each hospital based on historical spending trends, whereby annual revenues were subject to a fixed cap. Hospitals continued to receive fee-for-service payments, but had the ability to adjust their rates nominal amounts throughout the year to stay within budget.  

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/02/28/a-road-map-for-action-on-health-care-spending-and-value-part-iii–spending-growth-targets/?sh=1911a1843e35

A Road Map For Action On Health Care Spending And Value: Part II – Price Regulation And Supports For Competition (Forbes)

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FORBES | This is the second in a four-part series on the Health Affairs Council on Health Care Spending and Value’s February 2023 report, “A Road Map for Action.” Each piece details one of the four priority areas within the report, which include recommendations on how the US can take a more deliberate approach to moderating health care spending growth while maximizing value. I served as co-chair of this initiative, along with former FDA Commissioner Dr. Margaret Hamburg. This piece outlines our recommended actions on price regulation and supports for competition.

Why does the US spend more per capita on health care than any other nation? Well, according to renowned health care economist Dr. Uwe Reinhardt, “It’s the prices, stupid.”

While that’s putting it simply, many believe, like Dr. Reinhardt so often stated, that our health care spending is more in large part because we are willing to pay more for it. And recent data suggest that we are indeed willing to pay a lot more for health care services. In fact, about 20% of our nation’s GDP was attributed to health care in 2020.

But it’s not just our willingness to pay more for health care in the US – and spending more or paying higher prices than other countries isn’t necessarily a bad thing. But doing either without seeing an improvement in quality of care is a problem. And this is exactly what is happening: high rates of growth when it comes to prices that are disproportional to the health and equity produced. This places a significant and increasing burden on everyone including our families, companies, and government.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/02/21/a-road-map-for-action-on-health-care-spending-and-value-part-ii–price-regulation-and-supports-for-competition/?sh=b6115f63a2f1

A Road Map For Action On Health Care Spending And Value: Part I – Administrative Waste And Inefficiencies (Forbes)

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FORBES | This is the first in a four-part series on the Health Affairs Council on Health Care Spending and Value’s newly released report, “A Road Map for Action.” Each piece will detail one of the four priority areas within the report, which provides recommendations on how the U.S. can take a more deliberate approach to moderating health care spending growth while maximizing value.

On February 3rd, the Health Affairs Council on Health Care Spending and Value released its report, “A Road Map for Action.” It’s the culmination of four years of study, debate, and collaboration between 21 experts in the healthcare field, each representing diverse sectors of the industry. Our goal was to take a nonpartisan, evidence-based approach to understanding our nation’s growing health care spending, the value we get from that spending, and to make recommendations on how we can maximize value while slowing spending growth.

I served as co-chair of this effort, along with former FDA Commissioner Dr. Margaret Hamburg. When we first embarked on this journey in January of 2019, we knew it would be a difficult challenge – reining in health care spending has been a stated goal of policymakers for decades, with little to show for it. Yet our task became even more complex with the upheavals in health brought on by the pandemic, and by the needed spotlight on inequities in all aspects of American life – including health care – that was raised by George Floyd’s tragic murder. As the world around us shifted, we worked to adjust, and extended our Council work by a year. We released our report this month, the product of four years of research and collaboration.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2023/02/13/a-road-map-for-action-on-health-care-spending-and-value-part-i–administrative-waste-and-inefficiencies/?sh=1e8dc3a9fd74

Recommendations On Health Care Spending And Value From 21 Experts: Why We Should Implement This Road Map For Action Now (Health Affairs)

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HEALTH AFFAIRS | Four years ago, an ambitious group of twenty-one diverse health care experts came together at the invitation of Health Affairs to collectively develop recommendations to maximize our nation’s investment in health care. With national health care spending levels reaching nearly a fifth of our economy, it was the right time to evaluate our spending priorities and the value we receive from those expenditures. 

At the time, we anticipated that the Health Affairs Council on Health Care Spending and Value, which we co-chaired, would be a three-year effort.  We did not foresee the first global pandemic in decades, leading to trillion-dollar federal investments in public health, nor the national reckoning on racial and gender-based disparities that brought to light many of the inequities in health care today.  The council continued to meet throughout, although our in-person meetings became virtual, and we continued to adjust and hone our analysis and recommendations as the world around us shifted. 

Even with these changes, we remained steadfast that this work needed to be done. As physicians first, we recognize that patients still struggle with the cost of care, despite policy changes like the Affordable Care Act. We’re seeing increased care avoidance, as a shocking 47 percent of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs. One in 10 Americans has medical debt, which continues to be the number one cause of bankruptcy. Despite the United States outstripping all other nations in per capita health care spending, our life expectancy is surprisingly on the decline. And in the midst of a crisis, when our physicians and nurses were our frontline defense against COVID-19, our health care systems needed billions in federal dollars to keep them afloat. Finally, our health spending continues to grow as a percentage of gross domestic product (GDP) and our federal budget. Taken together, this paints a picture of a system that is failing its people and where change is needed now. 

Read more at the Health Affairs blog: https://www.healthaffairs.org/content/forefront/recommendations-health-care-spending-and-value-21-experts-why-we-should-implement-road?vgo_ee=UmoGs8ja9YHQTo0EO2edhvlMy%2BOWWuyaZunZiCXh6gI%3D