Transition to the New Administration


Value-Based Health Care Is Here to Stay

With the 2016 campaign and election season concluded and the new year upon us, newly-elected and re-elected officials at all levels of government are turning their attention to the work of governing.

President-Elect Trump continues to be focused on transition work, assembling his team of Cabinet Secretaries and advisors and creating the agenda for his first 100 days in office. Healthcare is prominent in that agenda, with Republicans focused on delivering their campaign promise to repeal and replace the Affordable Care Act. Now is an important time to consider the future role of value in our healthcare system.

Aver is firmly committed to its mission of seamlessly making value-based healthcare the new norm. Aver will continue supporting healthcare payers and providers in their transition to a value-based payment system. The shift to value is driven by the need to contain healthcare costs,  an imperative for U.S.  economic competitiveness.  

We recognize the shift from volume (activity-based reimbursement) to value is not new. The journey of transforming our healthcare system reimbursement and reward began in the mid 80’s with the introduction of diagnosis related groups (DRGs), capitated payments, and most recently with  pay-for-performance programs, among many other delivery and reimbursement transformations.  

While we are confident that the direction in which the healthcare ship is pointed remains unchanged and while we stand firm in our goals, we also recognize that as a result of the election, this process will experience some change in the near-term. It is possible that the Trump Administration will rely on markets, rather than government, to drive the transition to value. Given that markets can often be more flexible and efficient than governments, this could increase the speed of adoption of value-based payment arrangements.

Until we get a better sense of the Trump Administration’s position on value, payers and providers may, understandably, feel uncertain about potential changes to ongoing and new payment systems, such as the new physician reimbursement system established by the Medicare Access and CHIP Reauthorization Act (MACRA). We believe the President-elect Trump Administration will continue to implement MACRA, due in large part to the law’s strong, bipartisan support in Congress. In fact, President-elect Trump’s Secretary of Health and Human Services nominee, Representative Tom Price, voted for MACRA and offered his expertise and experience as a physician to the Centers for Medicare & Medicaid Services (CMS) during its implementation.

MACRA is built on the value-based payment models and demonstrations created by the Affordable Care Act. Under MACRA, participation in these models will earn physicians a 5% bonus payment. Work on these innovative payment models must continue in order for physicians to access those bonuses. Trump’s nominee for CMS Administrator, Seema Verma, has worked on innovative implementations of insurance coverage expansion in many states, and we hope that spirit of innovation will extend to payment reform.

Which brings us to the Affordable Care Act, also known as Obamacare. The value-based payment provisions in Obamacare have largely flown under the radar when it comes to criticism of the law. We anticipate changes in the coverage provisions of the law, which will certainly have an impact on providers’ and payers’ bottom lines. But we do not see any changes  or efforts to roll back the overall move toward value.

The period following a Presidential election is always uncertain, and Aver stands ready to advise our clients through this transition and support their journey to value-based payment. Payers, providers, and government plans have worked with  Aver to create end-to-end value-based strategies. Aver will continue offering solutions to help healthcare organizations assess alternative payment strategies and effectively implement value-based payment models  Our commitment to value is stronger than ever. We are proud to be part of the solution.

President & CEO
Aver Inc.

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