By ALEX AZAR
Presidential transitions are at all times 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. financial system. President Trump has the chance to do exactly 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 larger prices and larger utilization of healthcare assets—however not higher outcomes for sufferers. In contrast, a VBC mannequin ties supplier funds to high quality affected person care that includes 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-Help and embrace system-wide modifications.
We even have extra proof than most individuals understand in favor of different care supply and cost fashions.
Important constructive modifications have already occurred within the main care house by means of packages just like the Medicare Shared Financial savings Program (MSSP).
Final fall, CMS introduced that MSSP achieved the largest annual savings in program historical past and the seventh consecutive yr of financial savings and high-quality care. As well as, there was vital enchancment in high quality measures associated to diabetes and blood stress management, in addition to screening for breast most cancers, colorectal most cancers screening, and melancholy.
However there’s nonetheless untapped potential to increase these features 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 fee curve, we’d like larger 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 Health (AAKH) Initiative. Our objectives: to forestall kidney failure by means of higher analysis and therapy, improve inexpensive therapy choices (together with dwelling dialysis), and broaden entry to transplants. This system paved the way in which for the value-based Kidney Care Choices (KCC) model, which is now in yr 4. First-year outcomes launched final fall present suppliers in KCC have been in a position to scale back prices whereas concurrently assembly sure high quality targets for sufferers with late-stage CKD and end-stage kidney illness.
We’ve additionally seen constructive leads to the non-public sector. I sit on the board of Interwell Health, a VBC kidney care firm serving nephrologists, sufferers, and payers. Taking part sufferers expertise a house dialysis begin price that’s 85 % larger than the nationwide common, a transplant price 41 % larger, and an all-cause hospitalization price that’s 20 % 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, after all, specialists, they usually coordinate care for his or her sufferers, serving as a type of “medical dwelling” for folks experiencing continual kidney illness.
I might say that round 20 % of medical doctors are enthusiastic in regards to the thought of VBC. One other 60 % are what I might 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 want 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 cut 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
