In the effort to move the health care industry toward value-based payment models, should the public or the private sector take the lead? Health insurer leaders shared their views during a June 6 panel discussion at the National ACO, Bundled Payment and MACRA Summit in Washington D.C.
“If payers are trying to differentiate amongst each other with their value-based care initiatives, we all lose,” said Brigitte Nettesheim, president of joint venture operations for Aetna Inc. “We can follow CMS, CMMI [the Center for Medicare & Medicaid Innovation] and make life easier for the providers and all work alongside each other and figure out other ways to differentiate in the marketplace.”
While Hoangmai Pham, M.D., Anthem, Inc.’s vice president of provider alignment solutions, pointed out that CMS has not always taken the lead in the move to value-based care, CareAllies President Julian Harris, M.D., said he thinks there’s “actually a lot to be excited about” when looking at what’s come out of CMS and CMMI in the past 12 to 18 months. Most notable to him is what he sees as the administration’s focus on simplicity.
Pham further added that public and private payers share similar goals, yet the challenge will be execution and operation, “which requires grappling with some complicated, pretty wonky issues and laying them out there for public discourse and then decision-making.”
Flexibility is also crucial when working with providers to design value-based payment models, according to Nettesheim. It is important to think critically about what each organization is trying to accomplish in the marketplace and design a model around those goals.
Pham warned that regulators must avoid thinking in black-and-white terms. She said she would “strongly encourage” CMS and state officials to be as clear-headed and as data-driven as possible when evaluating whether value-based payment models have worked.