What have we learned in the last 10 years about payment for value-based care?

June 20, 2022 / By Melissa Clarke, MD

For all the wonderful advancement in health care diagnostics and therapeutics, the U.S. health care system has yet to solve for high costs of care while also improving outcomes. These high costs lead an impending insolvency of the Medicare trust fund, while health disparities along racial and socioeconomic lines persist and are deepening, especially due to the COVID-19 pandemic. The shift of payment models to value-based away from fee-for-service (FFS) holds promise to address some of these very issues.  

My Inside Angle podcast guest, Dr. Amol Navathe, is the co-author on the 2021 Leonard Davis Institute of Health Economics publication The Future of Value-Based Payment: A Road Map to 2030. He gives valuable insight on notable successes and challenges with value-based payment. We discuss those advanced payment models that shift greater accountability onto providers and the levers now available to Center for Medicare and Medicaid Services (CMS) to move more providers away from FFS payments.   

Since the COVID-19 pandemic has highlighted the need for health equity even more starkly, we explore how value-based payment design can affect health equity. Experience to date shows that providers who care for underserved communities participate in value-based care programs at a lower rate and end up with less shared savings. One key observation is how do we design value-based programs so that historically underserved populations, both rural and urban, can experience improved care outcomes?  

Listen to this 3M Inside Angle podcast episode with Dr. Amol Navathe to hear more about how value-based payment models can evolve to meet some of the more vexing challenges in health care delivery. 

 Melissa E. Clarke, MD, CMQ, is senior medical director, health care transformation and health equity, at 3M Health Information Systems.