In October, the Biden administration set a goal Ensure that all Medicare beneficiaries participate in alternative payment models by 2030. Aneesh Chopra, who became the federal government’s first chief technology officer in 2009 and served in the Obama administration, argues that pushing for alternative payment models will not only lead to unnecessary spending, but also improve patient outcomes through higher utilization of preventive services and primary care visits. treatment effect.
Chopra, now CEO of health analytics firm CareJourney, has data to back up that claim. He said in a March interview with MedCity News that his company licensed the entire data set for CMS’ Medicare Advantage and Medicaid claims data, representing 145 million Americans.. A recent CareJourney analysis showed that Medicare patients enrolled in value-based care arrangements were nearly twice as likely to receive a mammogram.
The analysis reflects a theme that persists in CareJourney’s treasure trove of claims data: Accountable Care Organizations (ACOs) are doing a better job of reducing avoidable costs than providers who do not participate in ACOs with alternative payment models. The metrics used to measure this — preventable hospitalizations, avoidable emergency department visits, post-acute care utilization, etc. — all show ACO outperforming its peers, Chopra said in a recent interview.
He also noted that CMS also requires ACOs to report clinical data. HHS Office of Inspector General recently established ACO outperformed fee-for-service providers on 81% of quality measures, including blood pressure control and depression screening.
Unlike ACO’s value-based care model, the fee-for-service model is optimized for providers’ open schedules, so more patients can come to their clinics. In this model, providers are responsive to patients’ needs, rather than paying close attention to patients who have not yet sought care.
ACOs can assign patients a Care Manager to increase their engagement with the care plan. These care managers help providers be accountable to their patient populations, often issuing reminders for health visits and screenings, or scheduling follow-up visits after emergency room visits.
“The infrastructure is not funded on a fee-for-service model, but is rewarded in a value-based care program, which is why the CMS Innovation Center says it expects each beneficiary to have a responsible relationship because they will have a Trusted advisors — or for lack of a better term, quarterbacks — guide their care.”
Having a trusted healthcare advisor increases the likelihood that patients will seek preventive care, including cancer screening.President Biden’s February reboot Cancer Moon Landing The program has revealed a decline in cancer screenings during the pandemic, so CareJourney digs into its data to see if it’s a full-blown problem.
Chopra and his team found that providers who participated in the ACO were more likely to be screened for cancer, in part because they were scored on it. Their analysis showed that during the pandemic, Medicare patients enrolled in value-based care arrangements were 1.8 times more likely to receive mammograms than patients who did not. These results are consistent with the pre-pandemic period, where patients in value-based care arrangements also experienced higher screening rates.
Screening patients early not only means they have a better chance of overcoming a potential cancer diagnosis, it can also significantly reduce CMS’ cancer care spending. To achieve these results, Chopra said, shifting more beneficiaries to a value-based care model will require a larger campaign to recruit providers and beneficiaries in the ACO model, as well as to disclose the role of beneficiary selection. dialogue.
“The result is better quality and lower cost, so why aren’t we actively encouraging that? The answer is we’re doing this by trying to convince doctors to sign up for the program,” he said. “I think we should do more to encourage beneficiaries to see the benefits of being a participant, and maybe even encourage them to ask their doctor to enroll in the program.”
Photo: Feodora Chiosea, Getty Images
