By ALEX AZAR
Presidential transitions are all the time a time of nice change, however few leaders have ushered in a shift as sweeping because the rewiring of one-seventh of the U.S. economic system. President Trump has the chance to just do that by doubling down on the well being transformation achievements of his first time period.
A key to success is constant the shift from a fee-for-service (FFS) healthcare mannequin to value-based care (VBC). The present FFS mannequin continues to ship greater prices and better utilization of healthcare sources—however not higher outcomes for sufferers. In contrast, a VBC mannequin ties supplier funds to high quality affected person care that comes with prevention and coordination.
As a rustic, we’ve been dabbling with value-based fashions for many years. Now, the time has come to tear off the proverbial Band-Assist and embrace system-wide adjustments.
We even have extra proof than most individuals notice in favor of other care supply and fee fashions.
Important optimistic adjustments have already occurred within the main care area via packages just like the Medicare Shared Financial savings Program (MSSP).
Final fall, CMS introduced that MSSP achieved the largest annual financial savings in program historical past and the seventh consecutive 12 months of financial savings and high-quality care. As well as, there was important enchancment in high quality measures associated to diabetes and blood strain management, in addition to screening for breast most cancers, colorectal most cancers screening, and melancholy.
However there’s nonetheless untapped potential to increase these good points throughout the broader well being system. Whereas main care is a vital driver of value-based care, the fact is a majority of healthcare prices are attributed to specialty care. To proceed bending the price curve, we want better emphasis on specialty areas like cardiology, oncology, and nephrology.
In 2019, throughout my tenure as secretary of the U.S. Division of Well being and Human Providers (HHS), President Trump launched the Advancing American Kidney Well being (AAKH) Initiative. Our objectives: to forestall kidney failure via higher prognosis and remedy, improve inexpensive remedy choices (together with residence dialysis), and develop entry to transplants. This system paved the way in which for the value-based Kidney Care Decisions (KCC) mannequin, which is now in 12 months 4. First-year outcomes launched final fall present suppliers in KCC have been capable of cut back prices whereas concurrently assembly sure high quality targets for sufferers with late-stage CKD and end-stage kidney illness.
We’ve additionally seen optimistic ends in the personal sector. I sit on the board of Interwell Well being, a VBC kidney care firm serving nephrologists, sufferers, and payers. Collaborating sufferers expertise a house dialysis begin charge that’s 85 p.c greater than the nationwide common, a transplant charge 41 p.c greater, and an all-cause hospitalization charge that’s 20 p.c decrease than common. The result’s higher outcomes for sufferers and decrease prices for payers.
In some ways, kidney care is a helpful take a look at mattress for the efficacy of VBC in each main and specialty care. Whereas nephrologists are, in fact, specialists, they typically coordinate care for his or her sufferers, serving as a kind of “medical residence” for individuals experiencing persistent kidney illness.
I’d say that round 20 p.c of medical doctors are enthusiastic concerning the concept of VBC. One other 60 p.c are what I’d name “coachable”—which means that they might be prepared to make the shift in the event that they have been supplied with ample schooling about VBC fashions and enabling applied sciences.
That’s why the federal government must be a dependable accomplice on this transformation, offering secure, predictable frameworks that enable healthcare organizations to make long-term investments in care supply reform. We’d like higher knowledge sharing, constant high quality metrics, and aligned incentives throughout packages. Solely the federal authorities has the scope to help such large-scale change.
The brand new Trump administration has a possibility to scale back healthcare prices, enhance outcomes, and upend a system that virtually all people agrees isn’t working. We’ve already dipped our oars within the water, however the time for incremental change and small pilots has handed. Now it’s time to row ashore, burn our boats behind us, and totally decide to a brand new healthcare world that rewards worth over quantity.
Alex Azar was the Secretary of the U.S. Division of Well being and Human Providers from 2018-2021 and is at present a member of the board of administrators at Interwell Well being
