Comparing State Versus Private-Employer-Run Value-Based Purchasing

During this segment, Dennis Patrick Scanlon, PhD, invites the panelists to discuss whether a common ground can be achieved between state-run Medicaid agencies and private employer-run programs, with respect to value-based purchasing.

Francois de Brantes, MS, MBA, emphasizes a need for aggressive management of healthcare costs, pointing to several innovative state-run programs. These programs, says Mr de Brantes, have increased resident tax rates and have resulted in push-back. “The state government will have to find a way to react to that,” he adds.

As for private payers following the Medicare lead, Arthur Vercillo, MD, FACS, indicates that innovative private payer plans are often met with skepticism. Private payers introducing a new policy are often questioned by providers on CMS recommendations said Dr Vercillo; there is wider acceptance if the program comes directly from CMS instead of the private payer. Ateev Mehrotra, MD, MPH, agreed that it is difficult to do what Medicare—a dominant payer in many services—does.

Indicating that there is more innovation in the private sector, Dr Vercillo thinks that the Affordable Care Act will allow for increased collaboration among stakeholders.

Dr Scanlon asks the panelists the provider perception of these programs and whether they feel threatened that their practice may not meet the value standards. “Do providers need to change the way in which they practice to extract greater value?” he asks.

With an anecdote, Dr Vercillo suggests that all parties including patients, provides, and payers, have to work together. He goes on to emphasize the value of measuring data and comparing it to benchmarked standards and data from other providers to evaluate performance.