Jerry Penso, M.D., MBA
Jerry Penso, M.D., M.B.A., is president and chief executive officer at AMGA, a trade association that represents medical groups and other organized systems of care.
How to Prepare for Value-Based Care
Healthcare associations will need to help their members get ready for changes in Medicare and Medicaid payment and operation models—one association has already started.
Value-based care is an important issue for almost any association in the healthcare ecosystem. Yet there needs to be more clarity about what VBC means and what impact it will have. VBC is a stated objective of the Centers for Medicare & Medicaid Services, having set a goal of 100 percent of Medicare beneficiaries and most Medicaid beneficiaries in accountable care relationships by 2030. This dramatic evolution of the payment and operating models will impact many aspects of healthcare delivery. As healthcare association leaders, your role is crucial in increasing awareness of these changes and developing plans to prepare your membership.
Most define VBC as payment models incentivizing healthcare providers to be accountable for the quality and cost of care they provide for people with Medicare, Medicaid, or commercial payers. VBC not only encourages healthcare providers to work together to address a person’s physical, mental, behavioral, and social needs but also offers a unique opportunity to improve the quality and efficiency of care.
Addressing health equity is also incorporated into VBC by encouraging healthcare providers to screen for social needs and work with individuals to develop personalized treatment plans. The payment models often include specific quality and cost-of-care measures and financial rewards or penalties based on performance.
Success in VBC usually requires providers to develop new skills, processes, and infrastructure. Associations can play a crucial role in preparing their members for VBC through education, data-driven feedback on performance, and connection to other members working in VBC. Education can focus on the basics of VBC and the specific changes occurring in the association’s industry. Data on performance can help members determine their readiness for VBC and areas that need improvement. Creating venues for member networking can facilitate the sharing of best practices in VBC.
Case Study: The American Speech-Language-Hearing Association
The audiology and speech-language pathology fields have historically been paid strictly using the fee-for-service model, in which individual healthcare services, such as a hearing evaluation or swallowing therapy, are reimbursed based on their assigned current procedural terminology (CPT) code.
The transition to value-based care represents a novel concept and a complete paradigm shift for payment in the professions. The American Speech-Language-Hearing Association (ASHA) has invested resources to analyze and refine value-based care policy through legislative, regulatory, and private-payer advocacy while generating a wide variety of member education on the issue.
Profession-specific information on programs and policies. Health organizations often create value-based programs with physicians in mind. What does that mean for non-physician qualified health providers? ASHA creates and maintains web resources explaining the impacts of various value-based care policies and programs on the professions.
Member advisory group. ASHA established a small advisory group of clinicians who work in a variety of settings and across the life span to share their challenges and wish lists for implementing value-based care. Their monthly meetings inform association staff, and their work on annual conference content informs the general membership.
Resource generation. Cross-functional teams develop suites of resources to educate members on the clinical and technical upskilling needed to succeed under value-based care. Health equity is infused throughout the content and all of ASHA’s advocacy.
Value-based care represents an emerging new world for audiologists and speech-language pathologists. Through environmental scanning and foresight, ASHA has identified the change, invested in advocacy and education, and positioned itself to be ready and waiting when members need answers.
Get Ready for What Lies Ahead
Associations are in an ideal position to support their members in meeting VBC’s challenges and opportunities. Forward-looking leaders will want to learn more about VBC and begin developing the strategy and tactics that will best position their members for success.
Suggested Resources
- Douglas Jacobs, Elizabeth Fowler, Lee Fleisher, Meena Seshamani; The Medicare Value-Based Care Strategy: Alignment, Growth, And Equity; Health Affairs, July 21, 2022 10.1377/FOREFRONT.20220719.558038 (Douglas Jacobs, 2022)
- Basics of Value-Based Care | CMS
- Value-Based Care: What It Is, and Why It’s Needed | Commonwealth Fund