The Executive Suite: Health Equity and Value-Based Care 2.0 to Take Center Stage in 2022

There is no denying the impact COVID-19 has had on the nation, serving as a leading cause of death, and impacting millions of others from a societal and economic standpoint.

Yet from these darkest of times comes a renewed focus on health equity and sustainable value-based care. In January 2021, the new U.S. administration put a stake in the ground, signing an executive order that underscored the groups commitment to advancing racial equity and supporting underserved communities. Early efforts focused on ensuring that marginalized groups, such as those in rural areas, poor, older and ethnic minorities hardest hit by COVID-19, had equal access to vaccinations. The administration also continues to take steps to address the digital divide, since innovations in digital health offerings are outpacing the ability to get low-cost technology and Internet services into the hands of those who could benefit most from it. New laws are also allocating resources for personal technology and broadband connectivity to mitigate barriers to telemedicine.

Looking to the future, we can expect to see an expansion of these efforts, as agencies seek to improve access to basic healthcare, including primary care and mental health services, as well as management of chronic conditions through virtual care models. The continued commitment to reimbursement for virtual care is creating an on ramp to more holistic, value-based care delivery models, a transition that the original ACA legislation and reimbursement models of that era failed to do.

The 2022 Medicare Physician Fee Schedule (PFS) Final Rule, released in early November, for example, calls for telehealth services temporarily allowed during the COVID-19 public health emergency (PHE) to remain in place through calendar year 2023. These services include home visits for established patients, emergency department visits, critical care services, and hospital and nursing facility discharge day management services. The PFS also permanently removed geographic restrictions and added the home as a permissible originating site for telehealth services furnished for the purposes of diagnosis, evaluation, or treatment of a mental health disorder.

By extending the ability to provide these services virtually for the next two years, the agencies, as well as other stakeholders, can gather more information with the aim of justifying that these services should be permanently added to the Medicare telehealth list. Doing so would give patients more flexibility in the way they access healthcare and offer providers different ways to reach those who may have avoided care because of socioeconomic barriers or other issues that impacted their ability to visit their doctors in person.

New Incentives Driving Value-Based Care

To date, the evolution to value-based care has been slow. The pandemic highlighted the need for hybrid in-person and virtual models of care, and reignited calls for providers to be adequately compensated for these models. As these care models become increasingly more popular, it is also evident that they will be instrumental in the success of proactive, outcomes-focused care. In fact, nearly half of healthcare leaders said the pandemic would “propel the industry away from fee-for-service,” according to a September 2021 Insights report from Xtelligent Healthcare Media.

The Biden administration is also re-evaluating value-based models of care, signaling a value-based care 2.0 movement. The Centers for Medicare and Medicaid Innovation (CMMI) Director Elizabeth Fowler has confirmed that the agency is still resolute in its mission, but is refocusing. It plans to enact "fewer, but more targeted models" with an eye toward health equity, aligning different payers and improving the nation's primary care infrastructure. "We're at a really critical juncture in the path to value-based care," Fowler noted in an April speech. "We need to find a way to bring everyone along. We can't have fee-for-service remain a comfortable place to stay."

To that end, CMMI also is considering making the models mandatory, an approach that was started during the Trump administration. Fowler told Health Affairs Editor-in-Chief Alan Weil "what we have learned from CMMI models over the past 10 years is that voluntary models are subject to risk selection, which has a negative impact on the ability to generate system-level savings." She also indicated that models would focus more on the patient than the provider to ensure there is "meaningful accountability for quality and total cost of care" for Medicare and Medicaid beneficiaries. This change, she believes, could drive growth in telehealth and virtual care in an effort to lower the total cost of care.

These comments suggest that value-based care is not just a passing fancy, but something that will become more focused and sustainable over the long term. And with greater emphasis in the 2022 PFS, with the potential of permanent changes, telemedicine will be an important component. New models of care – such as hybrid ones that incorporate both virtual and in-person interaction – offer comprehensive continuous care that will support greater equity while also making outcomes-focused care, as well as payment parity, a priority for providers.

In 2022, I look forward to more productive discussions on how our industry can further usher in a new era of healthcare, implementing even more changes that are sustainable, beneficial and endure long into the future.