Spotlight Trends: Value as the Differentiator

Six years after the Medicare Access and CHIP Reauthorization Act (MACRA 2015), Vynamic’s Mindy, Ryan, and Jen discuss where we are today in the transition from Fee-For-Service (FFS) reimbursement to Value-Based Care (VBC). The episode opens with an acknowledgment that VBC is at a crossroads – the transition has been bumpy, VBC models have been “consistently inconsistent” (2:10), and the misalignment of payer and provider compensation models continues to be an ongoing challenge (3:18). The conversation then moves to what is needed for this transition to VBC to be successful; it requires operational overhaul (5:10), robust analytics, appropriate engagement of providers, and health system transparency. Innovation takes time and transitioning to VBC requires a shift in cultural mindset and a detailed strategy for change and adoption (8:10). The episode then explores what VBC means for Life Sciences companies, as the industry starts to reckon with the development of more expensive products with higher intrinsic value (14:50), including curative one-time treatments and gene therapies. From a market access perspective, Life Sciences companies should be creative with contracting and how they approach payers and providers about the products they bring to the market (15:18). Ultimately, these stakeholders will need to reach a middle ground to make products accessible to the right patients (20:04). As an industry, we should strive for “the art of the possible” (21:33) and engage in cross-sector thinking to make VBC models successful. 

Podcast Tags: healthcare, MACRA, fee-for-service, value-based care, reimbursement, innovation, Life Sciences, strategy, market access, value-based payment over time (VBPOT)

Source Links – Below, we’ve listed links to some of the facts and resources discussed on this show.

– https://revcycleintelligence.com/features/entering-the-next-phase-of-value-based-care-payment-reform

– https://www.fiercehealthcare.com/payer/new-cmmi-director-says-value-based-care-models-at-crossroads?mkt_tok=Mjk0LU1RRi0wNTYAAAF8k4XqnunZZyMo3p_xn3tEs3yH708uXgCNuApAFnJQHSR0EYcv1E2LCt6NlhnrwdH2JyVf-V_pxlSfU24GHKz3P3xDIZMa8jQIoLXYaPdibJyNaBh1Cc4&mrkid=152778267

– https://www.fiercehealthcare.com/payer/verma-says-value-based-care-models-haven-t-made-good-return-investment

– https://www.fiercehealthcare.com/payer/providers-call-for-another-chance-to-sign-up-for-direct-contracting-model?mkt_tok=Mjk0LU1RRi0wNTYAAAF8dKGQQGD5eCW9fP3QjJTt2D336_V8b5iB8tDE7JqOsFLKdsRpvjVAlrQMysKq4T7UamDcOD1mve6rocLCDDeRVC2cdYdiQ8iLjpaC6J0UFZyS_CaD5xk&mrkid=152778267

– https://www.fiercehealthcare.com/practices/medical-groups-urge-cms-to-walk-back-aco-quality-overhaul-citing-potential-negative?mkt_tok=Mjk0LU1RRi0wNTYAAAF824GfFyUI8FL_gS064nifCYSR3Zuk0KLpuNBZaeS1tB3UYGjMu883L-Dr2vtKP2pn19XwOcAZW-KlyrW9Zq1P7IUionDrt-hi739yRxkSO6YfNeiaYl4&mrkid=152778267

– https://revcycleintelligence.com/news/a-new-administration-value-based-payment-to-dictate-2021-success

– https://www.fiercehealthcare.com/practices/industry-voices-3-questions-providers-need-to-prioritize-as-they-look-to-take-more-risk?mkt_tok=eyJpIjoiWW1JeFpESmlPRFEwWkRsaSIsInQiOiJ2dlcwTkRqUUVsUUpUVm94T2h3cTd5UzNYcWp0cUJwZHpKVWUxZUxZVXRFVTFWamx4Ykh1NDJXckptYVIxZitFQzBDM1VvcncrWGRsQ1JNUzdDK2lOTURPOVQ2RVAzQmNib0dsWDVIOUhhMmlqOEpGc01aUGd4dktrU1RXNmVnWHpqaGFSb3RBYWdBZ3hOWXMzZnpzWkE9PSJ9&mrkid=152778267

– https://digitally.cognizant.com/value-based-care-in-life-sciences-whats-it-worth-to-you-third-of-a-multipart-series-codex5396/

– https://www.zs.com/insights/new-era-value-based-contracts

– https://www.bakertilly.com/insights/implications-of-value-based-care-for-the-life-sciences

For additional discussion, please contact us at TrendingHealth.com or share a voicemail at 1-888-VYNAMIC.

Mindy McGrath, Healthcare Industry Learning Lead

[email protected]

Ryan Hummel, Executive

[email protected]

Jen Burke, Healthcare Industry Strategist

[email protected]