When it comes to the federal government’s healthcare preference, the traditional fee-for-service payment model has increasingly been lagging behind value-based. It may not be surprising, therefore, to learn that a branch of the government has formally taken steps to advocate for value-centric policies.


Four members of the U.S. House of Representatives have come together to advance value-based healthcare and the platforms it requires. Representatives Ami Bera (D-Calif.), Mike Kelly (R-Penn.), Ron Kind (D-Wis.), and Markwayne Mullin (R-Okla.) have formed the bipartisan Health Care Innovation Caucus, and the word from the healthcare industry is a positive one.


“The main focus of the Health Care Innovation Caucus will be to explore and advance successful, innovative payment models as well as the technologies needed to support these models,” caucus co-chairs said in a press release last month.


“…improve the quality of care and lower costs…”


It’s true that there aren’t all that many legislative days remaining this session, and Congress’s highest priority over the summer will likely be campaigning for midterm elections. Still, even if policies aren’t inked this session, the caucus’s statement promises that representatives “will advance a legislative agenda that encourages innovative policy ideas to improve the quality of care and lower costs for consumers.”


Shortly before the news of the caucus was announced, the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma and senior White House adviser Jared Kushner made a value-based announcement of their own at the Health Information and Management Systems Society’s (HIMSS) yearly meeting in Las Vegas. Verma and Kushner are participating in a revamping of electronic health record (EHR) incentives with the goal of improving interoperability, the key to successful value-based models.


In a guest post for the technology blog Recode, Kushner and Verma wrote: “While tremendous progress has been made in ensuring health providers use Electronic Health Records (EHRs), patients too often are not able to access and share their records, and their doctor often lacks the complete picture of their health.”


HHS Secretary has a vision of “bolder action” supporting value-based models


A year ago, many in the healthcare industry were concerned that the Trump administration’s goal was to roll back all Obama-era value-based policies, as the CMS did with two mandatory bundled payment programs begun during President Obama’s tenure. However, Alex Azar, the Health and Human Services (HHS) Secretary appointed by Trump and confirmed in January, has maintained his support of value-based care and the advancements in technology that it demands. Azar has even promised “bolder action” in that regard. And prior to Azar’s confirmation, the Trump administration rolled out a new voluntary advanced alternative payment model.

Hospitals don’t need to be convinced about the value in value-based care


American Hospital Association President and CEO Rick Pollack told Modern Healthcare that hospitals have already begun bundling payments and implementing accountable care organization models.


“They are using new tools — such as predictive analytics and artificial intelligence — to better inform care decisions,” Pollack said. “Additionally, hospitals and health systems are at the forefront of researching innovative treatment options and therapies targeted to individual patients based on their unique needs.”


And John Rother, President and CEO of the National Coalition on Health Care (NCHC) had this to say in a statement that appeared on the caucus’s press release last month:


“There’s little more important to long-term health care affordability than moving beyond today’s costly, volume-centered paradigm. The leadership we expect from the new Health Care Innovation Caucus could be key to achieving that […] A long-time champion for bipartisan delivery innovation legislation, including MACRA and the Chronic Care Act, NCHC has urged the Administration to make expansion of Advanced Alternative Payment Models opportunities the top priority for the CMS Innovation Center.”



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