Value-Based Care Key to Bipartisan Healthcare System Reform

March 01, 2018 - A group of five governors developed a bipartisan plan to reform the US healthcare system by using value-based care strategies such as quality reporting, insurance stabilization policies, and encouraging consumers to have a more proactive role in their healthcare.

Governors John Hickenlooper (D-CO), Jon Kasich (R-OH), Bill Walker (I-AK), Tom Wolf (D-PA) and Brian Sandoval (R-NV) contend that bipartisan support at the state level can create national healthcare changes that implement value-based care.

“Governors across the country are leading efforts to transform their health care systems to produce better health outcomes at a lower cost to governments, employers and individuals,” the group said. “States play a key role in healthcare transformation as major purchasers of healthcare, as chief regulators and administrators, and as catalysts for bringing together diverse stakeholders around a shared vision for improving overall health system performance.”

The state leaders recommended a series of reform strategies based on four value-based care principles. These principles include improving healthcare affordability, re-stabilizing insurance markets through competition, allowing states the ability to create innovative health solutions, and improving the regulatory environment.

Encouraging value-based purchasing was among one of the major proposals to promote value-based care, which included three components.

States and federal leaders should actively measure provider performance in a fair way with technical credibility, rely on quality information and use incentives to help providers improve quality, and transition providers to holistic care coordination.

The plan also suggests that states develop insights on federal government programs that promote value-based payment models including Medicare, MACRA, Quality Payment Program, and the Federal Employee Benefits program.

The governors noted that consumers making healthcare decisions will be a critical factor of driving nationwide value-based care, and that enhancing healthcare consumerism will catalyze value-based care.

The plan called for supporting the use of the consumer-facing technology to support decision making, using financial incentives to drive cost-effective care, and providing educational resources to help consumers make better healthcare choices.

“Consumers play a critical role in the medical decision-making process and make multiple decisions in the path of care that ultimately impact the value of care delivered,” the state leaders said. “The federal government and states can work to align consumer-focused incentives and encourage the development of tools that provide consumers with the information they need to create value in our healthcare system.”

Additionally, the state leaders claimed that increasing health insurance competition will improve affordability and healthcare access for consumers across the country. These suggestions include encouraging competition among payers, improving data-sharing to inform consumers about insurance options, and limiting anti-competitive practices of healthcare organizations.

Reforming insurance markets is a top priority in the plan based on the argument that using a mix of federal and state stabilization tactics could improve healthcare affordability. According to the plan, the federal government has to re-implement health insurance market protections while encouraging consumers to actively seek out health insurance. The group additionally emphasized a need to provide low-income individuals with more health plan options.

Federal policy recommendations to fix insurance markets include reinstituting the cost-sharing reductions (CSRs), stabilizing risk pools through reinsurance and risk adjustment programs, and promoting enrollment with sufficient outreach programs.

States should maximize carrier participation by exempting carriers who offer plans in underserved areas from the federal health insurance tax in those areas.

The group concluded their report by suggesting that states use a mix of state-based policies and federal leadership to further drive value-based care across the nation.

The use of 1115 Medicaid demonstrations can help drive value-based changes, the group said. 1115 demonstrations can be strengthened if they incorporate social determinants of health, measure health and social outcomes, and help members transition from state-managed care to private insurance.

The plan also calls on federal leadership to help states transition to value-based care more quickly, given that federal leaders are in a strong position to streamline administrative processes and provide aligned governance for states participating in value-based programs.