As the COVID-19 pandemic continues, the U.S. movement toward value-based care has become less visible. Yet experts predict the pandemic will accelerate the shift to value-based care as budgets are constrained and there is increased focus on better managing healthcare spending and driving value. To support ASA providers as they embrace more value-based payment models, the Abbott Nutrition Health Institute (ANHI) has launched a new Value-based Healthcare and Quality Important Initiative microsite.
The ANHI Value-based Healthcare and Quality Important Initiative microsite is organized around where care is delivered, which should be useful to ASA members working in acute care, skilled nursing and long-term care, home health, specialty care or private practice and office-based care. One of ASA’s strategic priorities is Health and Well-being, including exploring systems of care that address outcomes. The ANHI microsite may be particularly useful because, as detailed below, it has direct links to information about specific Centers for Medicare & Medicaid Services (CMS) value-based healthcare and quality programs and measures, as well as other resources.
CMS Value-based Healthcare and Quality Programs and Measures
Today, less than 20 percent of Medicare spending is value-based. Last year prior to the pandemic, CMS announced its goal that by 2025, nearly 100 percent of Medicare spending would be tied to value-based care contracts—a goal that remains in place. This means that during the next four years, $1 trillion of healthcare risk—80 percent of Medicare spending—will shift from the government to hospitals, health systems and physician practices. Many providers will need to determine how to successfully transition from fee-for-service to shared risk and population-based payment models.
One place to start is to become more aware of models for value-based care. CMS has established multiple value-based programs to advance its three-part aim of optimizing health system performance based on improving the patient care experience, bettering the health of populations and reducing the per capita costs of healthcare. Many CMS programs specifically encourage providers to improve the quality, efficiency, patient experience and safety of care.
The ANHI microsite offers direct links to information about individual CMS value-based healthcare programs, for example, in acute care it links to the CMS Hospital Value-based Purchasing, Hospital Readmission Reduction and Hospital Acquired Conditions programs.
It also is necessary to understand CMS quality programs and measures. CMS is the largest payer of U.S. healthcare services and it is continuously seeking ways to improve healthcare quality. Its quality programs use payment incentives, payment reductions and quality improvement activities to enhance care quality, while also increasing transparency through expanded public reporting of performance results. Each site of care has specific CMS quality programs and measures; links to these are included in the ANHI microsite.
Additional Resources and Nutrition as a Social Determinant of Health
As ASA providers shift from a focus on volume to value it is helpful to consider what factors—such as social determinants of health—may affect the outcomes important in CMS value-based healthcare and quality programs. There is growing awareness and understanding that health outcomes and disparities are often driven by social determinants of health rather than by medical care alone.
Social determinants of health include social, economic, physical and other conditions such as poor nutrition or malnutrition that influence health and health outcomes. Malnutrition continues to be a growing crisis for older adults and has been exacerbated in the last six months as social isolation has intensified and lockdowns and social distancing have limited access to community nutrition programs and services. Effective screening, assessment, diagnosis and intervention for malnutrition, even during a pandemic, can help to reduce mortality rates, readmission rates, lengths of stay and costs, which are all important outcomes in value-based care. The ANHI microsite has links to clinical studies, education programs, infographics and other resources that help demonstrate the role of nutrition in health outcomes.
Value-based care is driving major payment reform in the American healthcare industry. The ANHI microsite gives ASA members direct links to information about CMS value-based and quality programs and measures. More importantly, it provides evidence of how quality nutrition can help providers deliver the best care at the most reasonable cost, thus improving the overall value of care and benefitting patients and their families.
Susan Drawert, MEd, RDN, is director, Government Affairs, at Abbott, in Chicago, Ill.