Medicare Moving Toward Value-based Care

You can easily see the huge variation in costs for treating heart disease across the US. Healthcare financing follows the Medicare system in this country. The Center for Medicare and Medicaid Innovation was established to accelerate the move to value-based care. Out of 50 models tested by the innovation center, only six yielded savings that led to broad adoption. Only one of those successful programs addressed a chronic disease and that was The Diabetes Prevention program. The Medicare system is moving towards greater adoption of value-based reimbursement with bipartisan support.

“According to CMS data for 2021, 53% of Medicare beneficiaries (30.5 million) were enrolled in traditional Medicare Parts A and B. In contrast, 47% of Medicare beneficiaries (27.2 million) were enrolled in Part C Medicare Advantage plans, which rely on capitated payments that are deemed to be value based. A total of 42% of traditional Medicare beneficiaries (13 million) were enrolled in accountable care arrangements.” Efforts to improve health and reduce cost in primary care including a test of the medical home model all failed.

This site is all about improving health and reducing costs in cardiovascular and related conditions. A model that will work to improve health and reduce cost in Medicare Advantage and ACO programs is the primary care Chronic Cardiometabolic Condition Clinic which is a comprehensive solution for these diseases. It is a systematic approach that combines evidence-based care processes consistent with best practices with a population health tool and AI-powered clinical and financial analytics. That combination has been proven and scaled in coronary artery disease. The same approach produces great results for type 2 diabetes and reduces heart failure admissions by 70%. Heart failure alone accounts for one third of Medicare costs. These are proven solutions. You don’t need to reinvent the wheel. We have the systems and partners worked out. wbestermann@congruityhealth.com