As we leave a tough 2021 in the rear-view mirror, 2022 brings with it some optimism as recent data suggests that vaccinated and boosted individuals have much lower mortality rates with Omicron.
On the value-based care (VBC) front, 2021 was an important year of growth and learning for payers and providers alike. Here at SpectraMedix, it is our job to stay on top of the latest advancements in VBC and anticipate what’s to come. Based on research our team has conducted over the course of 2021, and conversations we’ve had with customers and executives across the healthcare industry on their aspirations for value-based contracting, here are eight predictions for the upcoming year:
1. Transition from MSSP to MA arrangements
A greater number of ACOs/providers will switch their focus from the Medicare Shared Savings Program (MSSP) to Medicare Advantage (MA) programs. In 2021, the number of MSSP ACOs and assigned beneficiaries both declined for the second time in the last four years. Meanwhile, the number of Medicare beneficiaries covered under an MA VBC arrangement continues to expand. ACOs have had mixed success with the MSSP, while at the same time experiencing positive results under their VBC arrangements with MA plans. There are many value levers that providers and payers can together effect (e.g. risk adjustment, quality metrics, total cost of care, utilization, etc.), resulting in a positive financial impact for both and stronger opportunities to improve value-based care and outcomes.
2. Inclusion of Behavioral Health (BH) in VBC Contracts
For many health plans and providers, BH has been carved out. A larger number of plans, especially in Medicaid and MA, will incorporate BH as another chronic disease in their Total Cost of Care VBC arrangements. In fact, some plans will tailor their VBC arrangements to BH providers, especially for populations where BH is the predominant condition.
3. Both Health Plans and Health Systems Will Invest Significantly in Actionable Analytics to Succeed in VBC Initiatives
So far, the focus for providers and payers has been primarily on improving quality and risk adjustment. There is a considerable shift underway though where both are investing in the ability to deliver actionable analytics to advance additional VBC arrangements, especially for Total Cost of Care and Medical Loss Ratio (MLR).
4. Specialist Adoption of Shared Savings/Shared Risk/Capitation Arrangements
Providers, specialists in particular, have become more receptive to these arrangements since the COVID pandemic. Health plans will advance from pay for quality to shared savings, shared risk, and, ultimately, capitated arrangements with specialists.
5. Targeted VBC Arrangements for One to Four High Volume Providers
Health plans will create VBC arrangements for a targeted group of one to four providers based on the volume of members/patients in their network.
6. Contracting with Community-Based Organizations (CBOs) for SDoH and Health Equity
Health plans will continue to explore the most effective ways to incorporate health equity and SDoH into their VBC arrangements. Contracting with CBOs, directly or indirectly, is one approach. There will be significant focus and innovation in payment models on how health plans and providers address SDoH and health equity in 2022.
7. Episodes of Care Will Continue to be Adopted
Maternity episodes of care by Medicaid health plans will be a point of emphasis as improving maternal and child health is one of the key goals of Medicaid. Commercial and Medicare plans will continue to focus on hip and knee replacements and other episodes.
8. Medicare Direct Contracting Models Will Continue to Evolve
Provider groups are adopting Medicare Direct Contracting models, although it’s too early to predict the success and long-term adoption of these programs.
2022 promises to be a bold year in the evolution of value-based care models, contracts, processes, and technologies. Please feel free to comment or email me at email@example.com with any questions or thoughts. Here’s to a happy and healthy 2022!