Q&As

How Should Medical Providers Prepare for Value-Based Care?

Q&A with Dr. Andrew Agwunobi, chief executive officer & executive vice president for health affairs at UConn Health

UConn Health University Tower

Q

What exactly is value-based care?

Value-based care means that future health care payments to medical providers by patients, insurance companies, and governmental agencies will most likely be formulated using a combination of key high-quality care metrics of each hospital’s or doctor’s office’s performance, along with an average of state or national health care service costs.

Medicare has indicated that by 2018 it will move to a value-based payment model. It is anticipated that commercial payers such as insurance companies will follow suit. Failure to provide value-based care in the future will potentially result in decreased payer reimbursements, financial penalties by the Centers for Medicare & Medicaid Services (CMS), and a shrinking number of patients using a medical provider’s services.


Q

How can medical providers best adapt to this new growing trend?

All medical providers, small and large, need to ensure delivery of health care is as cost-effective as possible, and is truly improving patients’ experiences and outcomes. Providers need to implement quality improvement initiatives, track them closely, and make sure key clinical quality metrics are measured and met. But they must also focus on improving the “value” of care, contemporarily defined as health outcomes achieved per dollar spent.

To meet these new expectations and to remain competitive, many health care providers across the nation have been joining or creating accountable care organizations (ACOs). An ACO is a voluntary collaboration of doctors, hospitals, and other health care providers who coordinate care and adhere to quality and efficiency standards in order to provide the best patient care at the most affordable cost possible.


Q

How is UConn Health preparing for value-based care?

UConn Health recently completed a successful large-scale, aggressive cost and savings initiative that is yielding ongoing annual operating and financial efficiencies. Now to remain even more competitive and provide great care at the best cost, we are currently looking at creative affiliation opportunities. We are exploring joining one or more existing ACOs in Connecticut at a leadership level. Our goal is to increase patient access to health care, while improving quality of care and our patient outcomes, and reducing the costs of achieving such good outcomes for our patients.

As part of our efforts toward value-based care, this spring we will begin the implementation process for a new, integrated electronic medical record (EMR) system called Epic. This is a nationally recognized clinical documentation system with the functionality and the capability to integrate all of UConn Health’s patient information across clinical care locations, physician offices, and medical providers into one accessible database.

This EMR will allow the sharing and receiving of the latest medical history of patients being cared for both at UConn Health and at other institutions, while providing our clinicians, researchers, and educators with a state-of-the-art clinical platform to support their ongoing missions. This EMR endeavor will enhance high-quality and cost-effective health care delivery for our patients and people of our region, and will allow for increased population health management.

How Does the Supreme Court’s Latest ACA Decision Impact Physicians?

Q&A With UConn Law Professor John A. Cogan Jr.

Q

What was the immediate effect of the Supreme Court’s ruling in King v. Burwell?

The major effect was to cement the federal government’s implementation of the law. The case dealt with a very specific issue: the subsidies offered to low- and moderate-income people. Unlike the previous ACA case, King v. Burwell wasn’t a constitutional challenge, it was based purely on a question of statutory interpretation: Could the government give out subsidies? The Supreme Court said yes. Since the constitutional and major statutory challenges have failed, we may see opponents attempt to chip away at portions of the ACA they do not like, but I think it’s safe to say we won’t see any more major cases attempting to unravel the whole law.


Q

In the wake of the decision, we saw announcements by insurer Aetna that it intended to buy competitor Humana, and then that Anthem would buy Cigna. That would bring the number of major health insurers in the U.S. from five to three, with UnitedHealth the third. How will these mergers benefit the insurance companies, and how will they affect health care providers?

The post-merger companies will each have a larger share of the market, thereby consolidating their power. Consolidation allows insurers to increase profits through efficiency gains. But these larger insurers will also gain bargaining power with healthcare providers. This is important because providers are paid directly by insurers. If you have doctors and hospitals negotiating with several different insurers, they have the ability to walk away from any one of those insurers, giving providers some leverage. But if there are only two insurers, that leverage is diminished. Major hospital systems and large physician groups will still have some bargaining power because of their size, but individual physicians will see their bargaining power diminish further.


Q

Will the effect of the mergers be in line with the intent of the law?

The ACA’s express intent was to expand coverage, and it worked. There’s nothing in the ACA regarding industry consolidation. Nevertheless, the fallout of the ACA’s expansion of coverage – efforts by insurers to consolidate market share – was foreseeable. Now that the ACA is here to stay, federal and state regulators will have to wrestle with consolidation issues.