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 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 increased prices and higher 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-Help and embrace system-wide adjustments.
We even have extra proof than most individuals notice in favor of other care supply and cost fashions.
Important constructive adjustments have already occurred within the major 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 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 major care is a vital driver of value-based care, the truth is a majority of healthcare prices are attributed to specialty care. To proceed bending the price curve, we’d like higher 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 Companies (HHS), President Trump launched the Advancing American Kidney Well being (AAKH) Initiative. Our targets: to stop kidney failure via higher analysis and therapy, improve reasonably priced therapy choices (together with house dialysis), and increase entry to transplants. This system paved the way in which for the value-based Kidney Care Selections (KCC) mannequin, which is now in yr 4. First-year outcomes launched final fall present suppliers in KCC have been capable of 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 personal sector. I sit on the board of Interwell Well being, a VBC kidney care firm serving nephrologists, sufferers, and payers. Taking part sufferers expertise a house dialysis begin charge that’s 85 p.c increased than the nationwide common, a transplant charge 41 p.c increased, 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 check mattress for the efficacy of VBC in each major and specialty care. Whereas nephrologists are, after all, specialists, they typically coordinate care for his or her sufferers, serving as a kind of “medical house” for folks experiencing continual kidney illness.
I’d say that round 20 p.c of docs are enthusiastic in regards to the thought of VBC. One other 60 p.c are what I’d name “coachable”—that means that they’d be keen to make the shift in the event that they have been supplied with ample training about VBC fashions and enabling applied sciences.
That’s why the federal government must be a dependable companion 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 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 Companies from 2018-2021 and is at the moment a member of the board of administrators at Interwell Well being
