Summary: Building on an inauspicious decade of failed efforts to improve care or save money for Medicare, value-based care is now the darling of CMS and scores of private companies involved in its latest incarnation, REACH. Health and equity rhetoric aside, it’s all about profits for investors. Greed dressed up to be presentable in public.
Value-Based Care is a Pretext for Privatization, Counterpunch, July 13, 2022, by Kay Tillow
Later this month, right before Medicare’s 57th birthday on July 30, corporate health care and the government players who facilitate their lucrative businesses, will gather for a summit on value-based care. They will speak of driving health equity, of reaching underserved communities, of coordination of care, and accountable care. They will insist that physicians share in risk just like insurance companies. They will advocate the transformation of health care to value-based care, supposedly founded on payment for quality rather than quantity, value instead of volume, and outcomes not fee-for-service. They will assert that this transformation brings equity, improves care, and saves money. …
While the [Center for Medicare and Medicaid Innovation] projects have not proven to enhance quality nor to save money, they are very successful at the hidden goal—the insertion of private profit-makers into the health care system and the privatization of Medicare and Medicaid.
Comment:
By Ana Malinow, M.D.
On the eve of Medicare’s 57th Birthday, no fewer than five former Administrators of the Centers for Medicare and Medicaid Services (CMS), three of the biggest medical professional societies, almost a dozen academic institutions, influential health policy think tanks, and over 30 corporations will convene to save our sinking primary care ship using value-based care. But like a lifesaver full of holes, value-based care will prove to be another dud unable to control costs and improve care. Worse than that, as Kay Tillow brilliantly wrote last week, “value-based care is a pretext for privatization.” Tillow connected all the dots, naming names, uncovering links, and exposing the players who are set to dole out public dollars for private gain.
The lifeline we are tossed is ACO REACH, the latest invention out of the Center for Medicare and Medicaid Innovation. HJM has pointed out fundamental problems with REACH: excess profit, paltry equity efforts, and impaired physician-patient trust among them.
REACH promises to bring value-based care to all of Medicare by 2030. As Tillow points out, this will not address the ineffectiveness of a system that led to 339,000 unnecessary COVID deaths nor combat the low US life expectancy compared to peer countries during the COVID pandemic. Value-based care, for all its aspirations to achieve equity, will not make a dent in our highly racialized decrease in life expectancy. While American life expectancy decreased by 2.41 years during the first two years of the pandemic, American Indian/Alaska Native individuals lost almost 5 years, making the life expectancy of AIAN men in the US, low before the pandemic, now comparable to that of men living in Afghanistan.
How are these players suggesting we transform primary care? Listen to a series of 15 “market movers,” all of which target senior care and are Direct Contracting Entities (soon to be ACO REACH), tech platforms to enhance value-based care, underwriters of the delivery of value-based care, or otherwise involved in helping primary care providers earn additional revenue. At least 14 of the 15 movers are publicly traded or investor owned. Or sit down for a fireside chat (end of July, no thanks!) with two companies, one publicly traded and another one backed by venture capital, focusing on delivering care to the underserved. Or take in a seminar on driving equity in primary care with Chief Innovation Office of One Medical, funded by Carlyle Group. Or learn about partnerships with private equity. Or listen to health care disruptors Google, Walgreens, and Amazon.
If you don’t think value-based care is all about privatization, think again. As Tillow writes, this “upcoming corporate extravaganza” will sink us for good.
Instead of privatizing the health care system, we should be organizing for a national, single payer program. That’s the lifeline we need.
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