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What We’re Watching: October 1, 2019

SINK OR SWIM

CMS administrator Seema Verma issued another “sink or swim” ultimatum to the healthcare industry to either reduce patient costs, embrace value-based care and increase transparency, or face extinction from a government-run, single payer, “Medicare for All” plan. “Patients are demanding more accessible, real-time personalized information to understand their options and pick high-value providers,” she said.

What we’re saying: It’s bold but realistic rhetoric. When value-based models are implemented effectively, they save money for taxpayers and improve the patient experience. In fact, 2018 MSSP ACO performance was just released, showing that the program generated nearly $740M in net savings last year. The health systems we work with have been leaders in these models, however there are a few barriers to advancing them, especially as providers take on more risk. Providers need better economic incentives, they need access to timely and accurate claims and EHR data, and they need regulatory flexibility and clear policy solutions.

MEDICARE ADVANTAGE IS GROWING

CMS released its Medicare Advantage outlook for the 2020 plan year, citing a 14 percent decrease in premiums and projecting an optimistic 10 percent member growth rate.

What we’re saying: As the fastest growing healthcare insurance product in the U.S., many provider participants in Medicare Advantage are considering migrating to models that include additional upside or two-sided financial risk. Whether assuming delegation of administrative services or forming their own health plans, the reality is that risk-based Medicare Advantage programs could mean greater payouts for providers that can deliver high-quality care and improve the patient experience.

FOCUS ON SDOH

A new report calls on government agencies and healthcare providers to increase their focus on the role that social determinants of health (SDOH) play in American’s physical and mental health. It found that industrialized nations that devote more resources to social services than healthcare tend to have better health outcomes.

What we’re saying: This follows another recent study that stated 90 percent of health outcomes are a result of social, behavioral and economic factors, rather than medical care. And it dovetails with Premier’s report earlier this year on improving care for patients with chronic conditions and the industry’s focus on value-based payment models for primary care facilities.

IN CASE YOU MISSED IT

What We’re Watching is a bi-weekly blog focused on the current events Premier is following and their relevance to the work of Premier and its members. Check out our last update!

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