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.
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Mindy McGrath, Healthcare Industry Learning Lead
Ryan Hummel, Executive
Jen Burke, Healthcare Industry Strategist