Introduction: Value-Based Purchasing in Healthcare Reform

During the opening segment of this program, part of the Healthcare Reform Stakeholders Summit, Spring 2015 series, moderator Dennis Patrick Scanlon, PhD, asks managed care stakeholders for their insights on the goals of healthcare professionals in value-based purchasing programs and the roles of various stakeholders in these programs.

Ateev Mehrotra, MD, MPH, notes that the transition in our healthcare system from volume-based to value-based will force providers to focus on quality, to achieve improved health at reduced costs.

Two categories of payers actively influence value-based purchasing, comments Francois de Brantes, MS, MBA: employers and consumers, whom he refers to as “the new generation of purchasers.” According to Mr de Brantes, a combination of both employers and consumers as payers is driving the change in payment for healthcare.

Arthur Vercillo, MD, FACS, agrees that consumers are the driving force for value-based purchasing programs, adding that the intent of the Affordable Care Act (ACA) was to provide increased access to healthcare. Dr Vercillo, commenting on value in terms of cost and quality, says he doubts if consumers have always gotten their money’s worth, and that value-based purchasing programs are a step in the right direction.

Medicare is the driving force that everyone else follows, according to Dr Mehrotra. While private payers are innovating and seeking alternate models, he strongly believes that Medicare took the lead in terms of initiating value-based purchasing programs, followed by the introduction of similar programs by private payers.

As the discussion continues, Mr de Brantes explains that employers have been a pioneer in this movement since the 2000s, while private sector payers are operationalizing various models more broadly. Acknowledging that private sector payers have gained from the groundwork laid by the ACA and the Center for Medicare & Medicaid Innovation, Mr de Brantes proposes that consideration should be given to what the private sector could and should be doing to drive these efforts forward.