Ep 27 – The Future of Value-Based Care: 2021 and Beyond, with Andrew Croshaw

As we prepare for a new era in our government with President-Elect Biden’s administration and a Democratic-controlled Congress, we must be steadfast in our commitment to value-based care. Can soon-to-be President Biden capitalize on this historical moment of unrest to unite our country with a value-based care policy agenda? Is COVID-19 truly a silver-lining moment for the value movement? How will providers, payers, policy-makers, public health, and patients leverage increased regulatory flexibilities, technological innovations, and major cultural shifts to fast-track strategic priorities that support the triple aim?

Our guest this week is Andrew Croshaw, Chief Executive Officer of Leavitt Partners. Andrew’s insights inspire and inform. Supported by leading-edge health care value economy research and intelligence from Leavitt Partners, this episode will provide you with the best policy analysis out there on this “Race to Value.” For additional information on the topics discussed in this episode, make sure to download the latest ACLC Intelligence Brief, The Future of Value-Based Care: 2021 and Beyond.

Episode Bookmarks:

1:40 A nation’s sadness due to recent events that have unfolded in Washington, D.C., and hope for a peaceful transfer of power in our democratic republic

2:40 Value-Based Care in the new era of government with President Biden’s administration and a Democratic-controlled Congress

3:13 How the value movement will allow us to improve population health and remain competitive in a global marketplace

3:40 The moral and economic imperative to make value-based care work

4:34 Referencing the newly-released ACLC Intelligence Brief entitled, “The Future of Value-Based Care: 2021 and Beyond”

6:20 Andrew’s personal reflection on the recent violence at our nation’s Capitol and the need for human connection and civility

7:10 How lack of accountability and the divisiveness of social and mainstream media creates incivility and violence

8:40 Hope for a moment for renewal and a better tomorrow

8:53 How the recent Georgia runoff election, giving control of the Senate to Democrats, will enable additional pathways for President Biden’s health policy agenda

9:12 Progress independent of any bipartisanship with elements of the health policy agenda that will still require bipartisan support

10:00 Passage of legislation in the Senate with a budget maneuver called “reconciliation” that can allow legislators to pass certain bills with a bare majority of votes (not the typical 60 votes required)

10:27 “I am encouraged for a sense of bipartisanship based on us learning how precious and fragile we now realize stability in our country really is.”

11:50 COVID-19 emphasizing the need for significant payment and delivery transformation, showcasing the advantages of prospective, non-FFS-based alternative payment models

12:20 Leavitt Partners’ monitoring of public and private sector value-based contracts showing that “Value-based contracts continued in 2020 despite the pandemic.”

13:15 Increase private sector focus on value-based payment (e.g. bundles, specialty ACO models, traditional ACO contracts)

13:27 Medicare Advantage, as a segment of value-based care, showing significant growth and newly-emerging plans are working well for beneficiaries and sponsor

14:12 Large employer advocacy of value-based care and how their voice will continue to grow louder

14:52 Startups forming meaningful partnerships with employers in the value space and how that will be disruptive over time

16:05 The promise of high-touch, full-risk primary care organizations (like ChenMed) as an important driver of value transformation and an influencer of health policy reform

17:20 “One of the benefits of 2020 was that it did highlight the benefit of taking risk to primary care providers. (I am a little afraid, also, of what that signaled to payers.)”

17:30 Historical reluctance of payers delegating risk and how that paid off for them in a big way with record profits in 2020

18:58 “The asset-light orientation of high-touch primary care, coupled with a full-risk business model, will continue lead transformation in value-based care.”

22:20 Continued suppression of hospital volumes due to COVID-19, growth in infection rates, and new variants of the virus will continue to pose financial stress on health systems

23:20 Health systems getting out of value-based contracts should continue to be expected.  Successful transition to value-based care will ultimately come down to who has the right perspective on timing.

23:30 “Transitioning too early will be just as poor of a decision as not transitioning to value at all.”

23:55 The electrification of vehicles and those that will continue to make internal combustion engines as a parallel to the health industry’s transition to VBC

24:45 The 3-5 year impact of the post-COVID economy have on the move to value and the exhaustion of the Medicare Trust Fund

25:41 Consumer embrace of virtual care will embolden both providers and policymakers as a component of value-based care

27:10 The Biden Administration’s definition of “value” will include components of social justice, health equity, and consumer transparency

30:33 The “dangerous and dynamic” nature of the Post-Acute Care business model due to disruption by stakeholders upstream (hospitals) and downstream (home care, primary care)

33:15 Carving in hospice care in MA plans will enable them to be leveraged more effectively in value-based models

35:30 Potential, but limited, opportunity to capitalize on COVID-19 vaccine innovation within the pharmaceutical industry

38:20 How the trend toward “payvider” models that involve deep, formal collaboration between a payer and a provider organization will impact value-based care

41:55 The uncertainty of whether or not continued underfunding of the public health sector will continue

42:50 Renewed focus on public health in the prevention and management of chronic disease

43:41 Failure to capitalize on the raised awareness of the broken public health system during the H1N1 pandemic and how COVID should be different

46:20 Challenges with nascent and emerging innovations (e.g. solar cells, electric cars) as a metaphor for how we should interpret the performance results of the MSSP and CMMI’s APM portfolio

47:30 Policymakers demand of more mandatory value-based payment models

49:30 “This isn’t just a health care journey.  Reforming the medical industrial complex is critical to the future of our country’s economic success in a global marketplace.”

51:30 If President Biden is re-elected in 2024, those two terms will define the transition to VBC because of trends that were accelerated due to COVID-19.

52:15 The leadership of WGU and the Accountable Care Learning Collaborative as an enabler of higher education focus and peer learning in value-based care.