Value-Based Care Expands Patient Access to Vital Health Services

Value-based care models have generated billions of dollars in savings to Medicare over the last decade and produced higher-quality care for patients. This improved care is made possible by Medicare incentives for providers who embrace value-based care, but the eligibility to earn this critical support will expire at the end of the year—unless Congress acts.

How Does Value-Based Care Improve Access?

Because value-based care focuses on outcomes, patients served by value-based models have access to services that go beyond what is historically considered “healthcare,” like personalized care based on social factors and collaborative support across health systems.

These extra services lead to better health, but they require additional funding and staff time. High investment costs make it difficult for many practices, especially smaller practices or those in rural or underserved communities, to transition to value.

How Have Patients Benefitted?

Patients recognize the promise of value-based care. To help more patients benefit from value-based care, Congress created a 5% incentive for physicians and other clinicians participating in Medicare’s advanced alternative payment models. The incentive allows practices to cover costs for services that improve patient health and wellbeing but cannot be reimbursed through traditional Medicare. One primary care practice in Pennsylvania used the incentive to create a 24/7 phone line to help keep its sickest patients out of the hospital. Other practices have used it to connect patients to safe housing, assistance paying for prescriptions, specialty care, and support for family caregivers.  

“What value does, or outcomes-based payment does, is it then allows us to invest in these things that you’re not reimbursed for in the regular fee-for-service world to give that better care,” said Dr. Ashish Parikh, chief quality officer of Summit Health/Village MD, at a congressional briefing hosted by the Alliance for Value-Based Patient Care earlier this year. “And then it’s a win-win-win for the patient, for the provider, for the group, for the payer, and for the country.”

"It's a win-win-win for the patient, for the provider, for the group, for the payer, and for the country."

By enabling physicians and other clinicians to address social factors that affect health—like housing, transportation, and food insecurity—the incentive for value-based care is also a powerful lever to help advance health equity. The incentive also increases parity between Traditional Medicare and Medicare Advantage (MA) by allowing physicians and other clinicians to offer services resembling the supplemental benefits previously only available in MA.

Extend the Incentive: For 300K Physicians and Other Clinicians and More than 14 Million Patients

Nearly 300,000 physicians and other clinicians rely on the incentive for value-based care to ensure all patients have access to the personalized, wrap-around services they need to be healthy. Eighty-four percent of accountable care organizations said the incentive was “extremely important,” and nearly 60% said they used the incentive to reinvest in patient care initiatives.

Nevertheless, the eligibility to earn incentive payments will expire at the end of 2023. When it does, more than 14 million patients will lose access to the high-quality, personalized care it enables.

This future is not set in stone. Congress can still extend the incentive. A bipartisan group of representatives introduced the Value in Health Care Act of 2023, which includes a two-year extension of the incentive, among other provisions to support physicians, clinicians, and patients participating in value-based models. The Senate Finance Committee included an extension of incentive payments during its mark-up this week, while expressing support for value-based care and working on ways to incentivize it in the future. Last month, the House Energy and Commerce Committee reviewed legislation to extend these crucial incentives, as well.

This movement is encouraging, and the Alliance appreciates Congress’s longstanding commitment to promoting high-quality, cost-efficient healthcare. Now it asks that Congress seal the deal: Extend the incentive for value-based care—for patients like Michael, Arthur, Wanda, Ron, and millions of others like them.

Learn more at valuebasedcare.org.