Outlook for 2017: Value-based payment will continue, but who will lead the way?

Value-based payment is likely to survive under the Trump administration, though who leads these initiatives and how they are structured may change.

“Healthcare systems will still want to think about that transition from volume to value,” said Derek Feeley, CEO of the Institute for Healthcare Improvement.

What's less clear is who will take on developing, testing and implementing alternative payment models given the possibility that Republicans will move to eliminate or limit the authority of the CMS Innovation Center.

HHS secretary-nominee Dr. Tom Price has called for the CMS to “cease all current and future planned mandatory initiatives under the CMMI.”

He also has criticized the growing demands on physicians to report performance measures, which typically are a key part of value-based models.

“What is the societal payoff from all these value-based initiatives will be a question Dr. Price asks,” predicted Jeff Goldsmith, a national adviser to consultancy Navigant Healthcare. “He will be disappointed in the answers that there aren't any savings so far.”

As a result, Goldsmith sees a doubtful future for government-led initiatives.

Some observers see better prospects for voluntary rather than mandatory models.

With a voluntary approach, “you're somewhat letting the private market dictate participation,” said Clay Richards, CEO of naviHealth, a private post-acute care management company.

Commercial insurers already have adopted voluntary bundled-payment models, Richards noted. “The need to transform our healthcare system is not going away,” Richards said.

Quality and patient safety concerns surround the looming implementation of the 21st Century Cures Act, signed into law in December. It will speed Food and Drug Administration approval pathways for certain drugs and medical devices.

Rep. Jim McDermott (D-Wash.), a psychiatrist who voted against the legislation, said it grants pharmaceutical companies license to sell drugs “before anyone finds out what the side effects are.”

The act, he said, fails to protect patients and to ensure new therapies are “run through the sieve of safety.”

Other efforts to enhance quality and safety are likely to continue, though funding is a question mark if the Affordable Care Act is repealed.

The coming year should see a shift away from one-off projects and toward building “systems of safety” that are “reliable and resilient,” Feeley said. Other efforts include reducing socio-economic disparities in healthcare and improving practice conditions for burned-out doctors.

“The policy environment can create a set of conditions that are either favorable or unfavorable for quality improvement,” Feeley said. “It's too early to tell exactly what that new environment policy is going to be.”