Enabling Health Care Resilience During and After the COVID-19 Pandemic
The coronavirus (COVID-19) pandemic has created unprecedented challenges for health care organizations. Clinicians, hospitals and other providers must simultaneously support efforts to contain the pandemic, maintain continuity of care for patients with ongoing care and social needs, and redesign care delivery to protect patients and staff. Furthermore, many providers are facing steep declines in revenue, driven by the postponement of elective and non-urgent care. Importantly, there have been racial and other disparities in the treatment and health outcomes of patients with COVID-19, and more work is needed to reduce those disparities and improve equity in care.
A health care organization’s ability to respond to COVID-19 is partially driven by its payment structure. Organizations operating primarily under fee-for-service (FFS) payment are experiencing significant drops in revenue and often do not have the capabilities in place to respond to the pandemic. On the other hand, organizations engaged in value-based payment (VBP) models (especially those receiving prospective payments) have more stable revenue streams, and frequently have care coordination, telehealth, and data analysis capabilities in place that allow them to respond more effectively.
Leveraging Value-Based Payment to Enable Health Care Resilience
The Duke-Margolis Center for Health Policy has engaged providers, health care organizations, policymakers, and other leaders nationwide to develop a vision for the future of VBP.
- A proposal for a COVID-19 Health Care Response and Resilience Program, developed in partnership with Families USA and United States of Care, would provide additional financial relief to health care providers so they may better meet the ongoing challenges of the COVID-19 pandemic, while also facilitating greater provider participation in value-based payment models. The proposal is summarized here. Providers participating in value-based payment models have demonstrated resilience to the negative financial impact of the pandemic and an ability to quickly pivot resources so they may continue safely caring for individuals and their families.This proposal describes how future financial relief offered to health care providers could help health care providers invest in the capabilities (e.g., data and telehealth infrastructure) that can support effective COVID-19 detection and containment strategies as well as facilitate shifts to value-based payment models that will be more resilient to future public health crises. Health care organizations, former health care policy leaders, and key health care stakeholder groups (see here, here, and here) support the continued transition to value-based payment as an approach to relief that enables additional payments to be an investment that will improve access and care, and reduce costs in the future.
To describe the advantages of VBP for the pandemic and beyond, and to support providers during this time, we have developed the following materials:
An issue brief sponsored by the Robert Wood Johnson Foundation, which explores how organizations were able to leverage value-based payment models to respond to the pandemic and support COVID-19 detection and containment. The brief also describes strategies that care delivery organizations have taken, under value-based models, to ensure care continuity for patients with chronic conditions when they are unable to receive in-person care. The brief emphasizes the need for more opportunities for organizations to participate in value-based payment models, given their ability to allow organizations to adjust their care approaches quickly during the pandemic based on people’s needs. Finally, it highlights the need to monitor and reduce disparities and improve equity as value-based payment models are rolled out more broadly.
A letter co-authored by center Director, Dr. Mark McClellan, and other former administrators of the Centers for Medicare and Medicaid Services proposing additional steps to support providers during and the COVID-19 pandemic. These steps include additional provider relief payments or loan forgiveness; tying such payments or loan forgiveness to pandemic containment activities and future participation in VBP models; and encouraging states and commercial plans to participate in these activities.
These materials were accompanied by a webinar, in collaboration with the United States of Care and West Health, to highlight how health care organizations are leveraging VBP to respond to COVID-19 and policy actions that can support VBP both during and after the pandemic. The webinar explored how to improve health disparities and equity, especially in making sure that payment reform improves health care and health for all Americans. Featured speakers include:
- Seema Verma, Centers for Medicare and Medicaid Services
- Mark McClellan, Duke-Margolis Center for Health Policy
- Andy Slavitt, United States of Care
- Brad Smith, Center for Medicare and Medicaid Innovation
- Meena Seshamani, MedStar Health
- Toyin Ajayi, Cityblock Health
- Griffin Myers, Oak Street Health
- Tim Lash, Gary and Mary West PACE
- Ryan Knopp, Stonecreek Family Physicians
- William Shrank, Humana