Key Insights

• CMS Administrator Seema Verma: “Our fee-for-service system is insufficient.” 
• Physicians in alternative payment models are more likely to leverage population health data, call centers, remote patient monitoring to treat COVID-19. 
• Some payers are implementing alternative payment models, such as global payments to preserve practices’ cash flow.

CMS Releases Population Health Data for COVID-19

Recent data from Centers for Medicare and Medicaid Services (CMS) reveals which Medicare beneficiary populations are most affected by COVID-19. “The data shows that older Americans and those with chronic health conditions are at the highest risk for COVID-19 and confirms long-understood disparities in health outcomes for racial and ethnic minority groups and among low-income populations,” read a press release. 

Some key insights include: 

• Patients with end-stage renal disease (ESRD) had the highest rate of hospitalization.
• “Dually eligible” beneficiaries, who enrolled in both Medicare and Medicaid, had the second-highest rate of hospitalization. 
• Black beneficiaries’ hospitalization rate was 278 percent higher than white beneficiaries. 
• Rural beneficiaries were hospitalized less often than those in urban or suburban areas. 

Verma remarked that the data highlighted the need for increased value-based care. “Now more than ever, it is clear that our fee-for-service system is insufficient for the most vulnerable Americans because it limits payment to what goes on inside a doctor’s office,” she said. “The transition to a value-based system has never been so urgent. When implemented effectively, it encourages clinicians to care for the whole person and address the social risk factors that are so critical for our beneficiaries’ quality of life.” 

Survey: Alternative Payment Models Linked to Innovative Care

Population health insights such as these are a cornerstone of value-based care. A recent survey from Premier Inc. found that “participants in alternative payment models (APMs) have drawn heavily on their population health capabilities to manage the COVID-19 pandemic and prevent the spread of the disease.” Among respondents that participate in APMs, 82 percent “leverage care management support to manage COVID-19” compared to “51 percent of those not in APMs.” Additionally, APM participants were more likely to use triage call centers, remote monitoring, population health data, and “claims data to understand care delivered outside the acute setting.” 

“Respondents participating in APMs had a significant head start over other healthcare providers in being able to provide quality and preventive care for their covered lives, all while managing an influx of emergency COVID-19 cases,” said Joe Damore, Vice President of Population Health at Premier. 

Growing Payer Interest in Value-Based Care

Some payers are responding to the call for more value-based arrangements. Independent Health, which is based in New York, has “stepped up value-based payments by giving primary-care practices an emergency global payment to help them maintain a monthly cash flow resembling pre-pandemic levels,” Modern Healthcare reported. In order “to ensure its members continue to receive their needed preventive services and medical care,” the organization has waived copays and cost-sharing for “fully insured employer groups, Medicare Advantage, Medicaid, and individual plan members.” 

This assurance and predictability may in fact help advance value-based care. As Sanjay Doddamani, MD, Chief Physician Executive and COO at Southwestern Health Resources, noted in a recent interview with RevCycleIntelligence, “Greater predictability is very aligned with value-based care, and moving away from encounter-based or transactional care will actually give greater accountability to physicians managing panels and populations.” 

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