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In 2021, the Centers for Medicare & Medicaid Services (CMS) Innovation Center set a bold new strategy for healthcare delivery which aims to have all or the majority of patients in value-based care models by 2030, signaling a shift away from traditional fee-for-service care models. This move emphasizes patient-centered care, affordability, and quality over the volume of services delivered.
The Importance of Value-Based Care
Value-based care is fundamental in how healthcare is delivered and paid for. Instead of reimbursing providers for the volume of services or patients seen, value-based models link payments to the quality of care provided. This shift incentivizes healthcare providers to focus on improving patient outcomes while reducing costs, which is especially critical in underserved and rural populations.
By aligning care delivery with patient outcomes, VBC models prioritize long-term patient health, coordination of care, and reducing healthcare costs.
Key Pillars of the CMS Strategy
- Driving Accountable Care: By 2030, all Medicare and most Medicaid beneficiaries will have care plans that hold providers accountable for quality and total cost of care. This is a significant step towards reducing fragmentation in patient care.
- Advancing Health Equity: Embedding equity into value-based care ensures that underserved populations, such as those in rural areas and safety-net hospitals, are not left behind. The CMS strategy includes setting targets for reducing disparities in care and encouraging participation from healthcare providers that have not previously participated in value-based care.
- Support for Care Innovations: CMS aims to encourage innovation in healthcare delivery by fostering integrated, patient-centered care. This includes supporting new technologies and data-driven approaches to improve patient outcomes and tackle care gaps.
- Addressing Affordability: Making healthcare more affordable is another strategic goal. CMS will explore strategies that lower the cost of high-value care services and reduce unnecessary care, ensuring that cost is not a barrier for patients.
- Partnering for System Transformation: Achieving a fully integrated value-based care system requires collaboration across the healthcare ecosystem. CMS plans to work with payers, providers, and state governments to align policies and priorities for healthcare reform.
What This Means for Covered Entities and 340B Programs
The CMS Innovation Center’s strategy for value-based care provides a critical opportunity for covered entities (CEs) participating in 340B. CEs are uniquely positioned to leverage data obtained through the 340B program to improve patient care and enhance financial sustainability.
An area where entities can leverage value-based care programs for their 340B programs is medication adherence. Specialty medications, which are often high-cost and used by complex patients, require significant care coordination. In a value-based care model, it is crucial to ensure patients adhere to their prescribed therapies in order to improve health outcomes and reduce healthcare costs (i.e. preventable readmissions).
As healthcare providers are increasingly held accountable for patient outcomes and the total cost of care, value-based models can help drive the reinvestment of 340B savings into initiatives that support better patient care. For example, providers can use savings to fund medication adherence programs and technology. This helps ensure patients with chronic conditions stay on track with their treatment.
The road ahead is clear: value-based care models are not just the future, they are the new standard for healthcare. Organizations that embrace this shift will be well-positioned to improve patient outcomes and drive cost efficiencies, aligning with CMS’s vision of equitable, person-centered care by 2030.
Call to Action
For 340B providers and health systems, now is the time to explore how value-based care models can further enhance their mission. By proactively aligning with CMS’s strategy, CEs can improve care quality and ensure their sustainability in an evolving healthcare landscape.
Does your organization have a plan in place to transition to value-based care? Reach out to us to learn how we can support your journey toward quality-focused healthcare.
Anthony Esgro, Chief Pharmacy Officer at Equiscript, can be reached at anthony.esgro@equiscript.com.
