The organizations that can take on 2-sided risk are usually bigger and that’s not always better for health care, said Jayson Slotnik, partner, Health Policy Strategies, Inc.
The organizations that can take on 2-sided risk are usually bigger and that’s not always better for health care, said Jayson Slotnik, partner, Health Policy Strategies, Inc.
Transcript
Do we need more organizations willing to take on downside risk in order to make real progress in transforming care delivery and realize substantial savings with value-based contracts?
So, value-based cancer care works in 1 of 2 ways. Either you've got 1-sided risk or you have 2-sided risk, right? That could be, either one could fit into a value-based contract. One-sided risk is just that, where one side is taking the risk, and usually there's not a lot of skin in the game on either side. CMS did this with something called the Oncology Care Model [OCM]. And it [produced] some savings, but after a while, quickly flattened out. However, on the other side is the 2-sided risk of value-based cancer care, which CMS tried to do through the OCM. It works somewhat, but again, didn't have a huge success.
At the end of the day, though, right, to take risk, you need to be big, you need to be large, you need to have sophisticated infrastructure to ascertain the risk, measure the risk, and understand where it's coming from and correct quickly. On one hand, that sounds great. On the other hand, my personal opinion: that that's actually bad for health care. Because what has occurred over the last, let's say, 10 years, ever since policies were put in place to incentivize double-sided, 2-sided risk vis-à-vis accountable care organizations, is that these organizations have gotten much bigger.
Hospitals have purchased lots of physicians’ offices in the community, the health payer has gone vertical, and you have 2 very large entities sitting down for a contract. And because they are each large, one can't live without the other. And so, there is actually an escalation in prices, certainly on the large provider side who says to the payer, “You can't have a health plan without me being in network. So here are my rates.” And that's where they start. And they don’t go right to a value-based contract. It takes a real stiffed back payer to push back and try to push it. We have not seen that yet. Because they haven't gotten that far. They have the flexibility of increasing premiums. And that's what's been done so far.
So, at the end of the day, do we need 2-sided [risk] in more organizations? Yes. Do they have to be bigger? I don't know that that's a success. Maybe what we need are more affordable tools for a smaller entity to be able to use, to equitize leverage with the health plan, in order to have a value-based contract without increasing premiums.
Covering antiobesity medications like semaglutide could save Medicare around $500 million annually; preliminary CDC data showed a 3% decline in the number of US overdose deaths last year; the Biden administration recently announced the first national maternal mental health strategy.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
After the ACA Expanded Health Care Access, 2024 Elections May See Voters Demand Affordability
May 15th 2024At the spring conference of the New Jersey Health Care Quality Institute, speakers discussed how health policy, affordability, and transparency may play a role in voters’ decisions.
Read More
Panel Addresses Minority Physician Shortage, Maternal Health at Senate Committee Hearing
May 15th 2024The senate hearing held by the US Senate Committee on Health, Education, Labor, and Pensions, led by Sen. Bernie Sanders (I, Vermont), chairman of the committee, and ranking member Sen. Bill Cassidy, MD, (R, Louisiana), addressed the critical issue of physician and health care worker shortages, as well as the maternal health crisis, in the US.
Read More