Summary: A blog in Health Affairs promotes ACOs and other VBP despite the lack of evidence for benefits. Why? Because VBP reinforces the corporate / private equity model of health care with growing profits for shareholders. We must elect those who would instead foster a truly equitable system.
[E]vidence suggests that the uptake of VBP models has lagged in marginalized populations, and that in some circumstances, VBP could exacerbate disparities. … [A]ddressing equity through VBP remains a nascent field with diverse approaches in use—with limited evidence on which approaches work or help avoid undesirable outcomes.
The Center for Medicare and Medicaid Innovation (the Innovation Center) recently announced that its Global and Professional Direct Contracting pilot will be redesigned into a new model called the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH). Reflecting the Innovation Center’s strategic focus on health equity as a top priority—and on achieving the broader equity goals of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS)—ACO REACH incorporates many new health equity-focused elements affecting upfront payments, data collection, provider selection, community governance, and delivery and benefit design.
ACO REACH is a substantial pilot program. It is aimed at improving equity but also at assessing which payment reform design elements can best do so while also achieving the “Triple Aim”—better care experience, better population outcomes, and lower health care costs. ACO REACH and the other equity-focused VBP models consequently provide an unprecedented opportunity for augmenting the meager evidence we have on how to improve equity.
In this article, we present a framework for categorizing the spectrum of approaches we identified for improving equity through VBP model design.
From the Conclusion: We hope this synthesis will assist the Innovation Center, state policy makers, and commercial payers to further their efforts to embed equity in VBP model design. However, these approaches are generally new, so more evidence is needed to understand what works best and should be replicated or adapted in future VBP models—including the experiences of ACO REACH.
National Primary Care Transformation Summit, July 26-29, 2022, Produced by Global Health Care LLC
Skim the presenter affiliations, which reveal a highly corporate vision for health care.
Medicare for All: Protecting Health, Saving Lives, Saving Money, Hearing, United States Senate Committee on the Budget, Chairman Bernie Sanders, May 12, 2022
By Don McCanne, M.D., M.P.H.
The two-part series in Health Affairs Forefront encourages pursuit of Value Based Payment (VBP) and specifically ACO REACH, despite an acknowledged lack of evidence that it works to promote equity (or savings or quality). It is yet another example of how the health care industry pursues a long-term trajectory toward private equity – corporate takeover of health care. No, the article does not say it in those words, but it does imply it in the infrastructure of the VBP models.
One glance at the landing page of the “National Primary Care Transformation Summit” should be all of the confirmation you need as to the intent for the future direction of our health care system.
Fortunately, Sen. Bernie Sanders has kept alive the concept of a single payer Medicare for All system by holding a hearing on the topic by his Senate Budget Committee and by reintroducing Medicare for All legislation.
Our problem is inertia. We talk about the clear advantages of single payer, but we have been ineffective in electing a president and Congress that will enact it. In the meantime, control of our health care system continues to shift to those holding the financial wealth of our nation. Their interests are not in correcting the severe deficiencies in health care but rather in accumulating more wealth. It is up to us to change that by instead putting control in the hands of the people who care about health care justice.