Like the proverbial tree falling in the forest, if the Centers for Medicare and Medicaid Services makes a major announcement about how its Shared Savings Program saved three-quarters of a billion dollars last year alone and no one notices, did the savings really matter?
No prominent national business publication gave significant coverage to the late September announcement about the impressive savings from this value-based care program.
CMS shared the announcement through a short series of tweets and an article in the Health Affairs blog by Seema Verma, the administrator of CMS. Coverage in trade publications was sparse. It was essentially a collective shrug about a government program that people were wringing their hands over just last year, one that health care insiders have suggested is as big a moment for health care delivery as we have seen in decades.
As the CEO of a successful accountable care organization (ACO) participating in the Shared Savings Program, I find this frustrating. After all, this program is considered to be a significant indicator on how its key players — physicians — are doing in the biggest health care transformation in decades.
So what to make of this media silence?
Despite the lack of attention, the 2018 data are a crucial benchmark in the health care system’s move away from fee for service and toward the new world of paying for value. Of the Shared Savings Program’s 548 participating ACOs, 205 earned savings through the hard work required to succeed: everything from skilled data analysis to identify gaps in care to investments in technology that delivers actionable insights needed to track progress at the provider level. The rest of the ACO cohort may need more time or the appropriate partner to achieve the same level of success, but it has been proven that when ACOs have the proper partner assisting with tools, technology, and talent, the savings they generate is remarkable.
More importantly, patients and families benefited from the program with an increased focus on wellness initiatives, faster recovery from illnesses and injuries, and proactively avoiding and managing chronic diseases, not to mention less time spent in hospitals and emergency rooms and reduced costs for outpatient follow-up visits. All of these are positive indicators of good things to come.
But there is much more that can be accomplished in terms of quality, cost-effective care delivered to patients, and dollars flowing to physicians as a result. What comes next — more acceptance of risk and a commitment by the private commercial insurance industry to emphatically shift toward value-based care — is important.
Let’s explore each.
More acceptance of risk
Part of Medicare’s Shared Savings Program and value-based contracts is taking on downside risk, meaning the risk of having to reimburse CMS for not meeting patient care benchmarks (this is also known as providers being accountable for outcomes).
But there is good news in that. In 2018, ACOs that took on downside risk performed better than those that did not. Higher performance creates savings for the system that can be shared with an ACO as long as it meets high quality standards. The opportunity to accept risk allows an ACO to address health concerns for patients and cost concerns for the health care system, in turn creating savings and delivering high-quality care.
This transition to value breeds innovation. With the right resources and entrepreneurial initiatives, it is possible to increase patient engagement and provide improved experiences for all involved in health care delivery. In effect, we are inching our way closer to achieving the quadruple aim: improving patients’ health, improving patients’ experiences with the health care system, reducing the cost of care, and improving the experience of health care providers.
More value-based contracts
Despite the headlines (or in this case lack of them) about value-based care, we still live in a world dominated by fee-for-service medicine, both within and, even more so, beyond Medicare’s Shared Savings Program. Over the course of my career, I have described the move to value as having one foot firmly planted in the fee-for-service canoe while carefully balancing the other in the value-based care canoe.
The industry fully understands that fee-for-service contracts won’t disappear anytime soon, and continues down a somewhat tumultuous path, fueled by the knowledge that greater alignment among the various parts of the health insurance system enables physicians to do what they do best: take great care of their patients and families without thinking about canoes.
The more aggressively the health care system sets its sights on moving to pay for performance (another way to describe value-based care), the better off the system and patients will be.
A victory lap is in order for Medicare’s Shared Savings Program demonstration of real merit, along with enthusiastic applause for those who made it worthwhile — and a plea for one heck of a better media plan to share the program’s results in 2020.
Shawn Morris is the CEO of Privia Health, a national physician organization focused on value-based health care.