| The skinny
Value-based care and Medicare Advantage are often heralded as two of healthcare’s most promising strategies for controlling costs, but industry leaders can’t quite tell if they’re actually working. Some have faith that value-based care and Medicare Advantage will soon deliver on their promise of lower costs, and others believe they’ve flopped when it comes to achieving their intended goal. A ripe opportunity
Michael Meucci, CEO of health data platform Arcadia, said value-based care programs need to move beyond focusing on coding optimization or star ratings and instead use value-based models to bring down costs by addressing fraud, waste and abuse. He sees a real opportunity there. “There's a bunch of healthcare costs that are just bad actors, and value-based programs monitor that data more regularly than anybody else,” Meucci stated. MA innovation
Meucci also pointed out that some payers reducing enrollment in Medicare Advantage plans could ultimately strengthen margins and encourage more innovation in the cost-containment arena. As insurers pull back from markets or benefits that have become less profitable amid higher utilization and tighter reimbursement, the plans that remain might be forced to operate more efficiently — which could create more room to invest in new care models and technology. And Risant Health CEO Jaewon Ryu noted that changes underway in Medicare Advantage, including reassessing supplemental benefits, could reshape the program as the country’s population ages. He said there’s a possibility these shifts could ultimately make the program more sustainable and responsive to patients’ needs. None too impressed
As a self-declared “dollars-and-cents guy,” Shawn Gremminger strongly pushed back on the notion that value-based care or Medicare Advantage is actually bending the cost curve. Gremminger, CEO of the National Alliance of Healthcare Purchaser Coalitions, argued that the fact Medicare Advantage continues to cost more than traditional Medicare raises doubts about the effectiveness of value-based payment models overall. “I've seen no proof that value based care is actually saving Americans money,” he remarked. Instead, Gremminger thinks employers will increasingly pursue direct contracting with providers, which he described as a simpler and more transparent method to reduce costs and gain more influence over healthcare purchasing. — By Katie Adams |
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