Six years after the Medicare Access and CHIP Reauthorization Act (MACRA 2015), Vynamic’s Mindy, Ryan, and Jen discuss where we are today in the transition from Fee-For-Service (FFS) reimbursement to Value-Based Care (VBC). The episode opens with an acknowledgment that VBC is at a crossroads – the transition has been bumpy, VBC models have been “consistently inconsistent” (2:10), and the misalignment of payer and provider compensation models continues to be an ongoing challenge (3:18). The conversation then moves to what is needed for this transition to VBC to be successful; it requires operational overhaul (5:10), robust analytics, appropriate engagement of providers, and health system transparency. Innovation takes time and transitioning to VBC requires a shift in cultural mindset and a detailed strategy for change and adoption (8:10). The episode then explores what VBC means for Life Sciences companies, as the industry starts to reckon with the development of more expensive products with higher intrinsic value (14:50), including curative one-time treatments and gene therapies. From a market access perspective, Life Sciences companies should be creative with contracting and how they approach payers and providers about the products they bring to the market (15:18). Ultimately, these stakeholders will need to reach a middle ground to make products accessible to the right patients (20:04). As an industry, we should strive for “the art of the possible” (21:33) and engage in cross-sector thinking to make VBC models successful. 

Podcast Tags: healthcare, MACRA, fee-for-service, value-based care, reimbursement, innovation, Life Sciences, strategy, market access, value-based payment over time (VBPOT)

Source Links - Below, we've listed links to some of the facts and resources discussed on this show.

- https://revcycleintelligence.com/features/entering-the-next-phase-of-value-based-care-payment-reform

- https://www.fiercehealthcare.com/payer/new-cmmi-director-says-value-based-care-models-at-crossroads?mkt_tok=Mjk0LU1RRi0wNTYAAAF8k4XqnunZZyMo3p_xn3tEs3yH708uXgCNuApAFnJQHSR0EYcv1E2LCt6NlhnrwdH2JyVf-V_pxlSfU24GHKz3P3xDIZMa8jQIoLXYaPdibJyNaBh1Cc4&mrkid=152778267

- https://www.fiercehealthcare.com/payer/verma-says-value-based-care-models-haven-t-made-good-return-investment

- https://www.fiercehealthcare.com/payer/providers-call-for-another-chance-to-sign-up-for-direct-contracting-model?mkt_tok=Mjk0LU1RRi0wNTYAAAF8dKGQQGD5eCW9fP3QjJTt2D336_V8b5iB8tDE7JqOsFLKdsRpvjVAlrQMysKq4T7UamDcOD1mve6rocLCDDeRVC2cdYdiQ8iLjpaC6J0UFZyS_CaD5xk&mrkid=152778267

- https://www.fiercehealthcare.com/practices/medical-groups-urge-cms-to-walk-back-aco-quality-overhaul-citing-potential-negative?mkt_tok=Mjk0LU1RRi0wNTYAAAF824GfFyUI8FL_gS064nifCYSR3Zuk0KLpuNBZaeS1tB3UYGjMu883L-Dr2vtKP2pn19XwOcAZW-KlyrW9Zq1P7IUionDrt-hi739yRxkSO6YfNeiaYl4&mrkid=152778267

- https://revcycleintelligence.com/news/a-new-administration-value-based-payment-to-dictate-2021-success

- https://www.fiercehealthcare.com/practices/industry-voices-3-questions-providers-need-to-prioritize-as-they-look-to-take-more-risk?mkt_tok=eyJpIjoiWW1JeFpESmlPRFEwWkRsaSIsInQiOiJ2dlcwTkRqUUVsUUpUVm94T2h3cTd5UzNYcWp0cUJwZHpKVWUxZUxZVXRFVTFWamx4Ykh1NDJXckptYVIxZitFQzBDM1VvcncrWGRsQ1JNUzdDK2lOTURPOVQ2RVAzQmNib0dsWDVIOUhhMmlqOEpGc01aUGd4dktrU1RXNmVnWHpqaGFSb3RBYWdBZ3hOWXMzZnpzWkE9PSJ9&mrkid=152778267

- https://digitally.cognizant.com/value-based-care-in-life-sciences-whats-it-worth-to-you-third-of-a-multipart-series-codex5396/

- https://www.zs.com/insights/new-era-value-based-contracts

- https://www.bakertilly.com/insights/implications-of-value-based-care-for-the-life-sciences

For additional discussion, please contact us at TrendingHealth.com or share a voicemail at 1-888-VYNAMIC.

Mindy McGrath, Healthcare Industry Learning Lead

[email protected]

Ryan Hummel, Executive

[email protected]

Jen Burke, Healthcare Industry Strategist

[email protected]