POLICY AND PAYMENT
Bigstock The Value-Based Care Crossroad:
Have ACOs Reached a Turning Point? The movement toward alternative payment models is surging, and CMS’ new ‘Pathways to Success’ regulation could serve as a defining moment for many ACOs. Those on the leading edge, however, have plenty of learnings to share By Rajiv Leventhal
T
he healthcare industry’s collective movement toward value-based care is an incredibly complex
one, filled with twists, turns and hurdles that oftentimes seem daunting. Within this ever-changing dynamic, however, there remains one constant: a bipartisan realization that traditional fee-for-service healthcare incentivizes providers to run up services and, there- fore, costs, leading the federal govern- ment to continue its push—albeit too aggressively to some—toward a value- based care and payment environment. Indeed, senior officials at the Centers of Medicare & Medicaid Services (CMS) have said that they want to have 100
percent of providers taking on some downside financial risk by 2025. There is no shortage of value-based
contracting initiatives that patient care organizations could partake in today as they continue on their journeys, from accountable care organizations (ACOs) to bundled payments, and other incentive-based forms of payment. The ACO landscape specifically has been one that some industry observers see as a key step to healthcare system rede- sign. One such person is Jeff Coughlin, the senior director of federal and state affairs at the Chicago-based Healthcare Information and Management Systems Society (HIMSS), who last year at a
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hcinnovationgroup.com | NOVEMBER/DECEMBER 2020
Healthcare Innovation Summit went as far as pronouncing that “ACOs are probably our best bet in terms of really doubling the shift from volume to value-based care.” Success in ACO initiatives is undoubt-
edly hard to accomplish, and takes a commitment
in achieving physician
buy-in, as well as significant invest- ments in technology infrastructure. And as if things weren’t dramatic enough already in U.S. healthcare, a “battle of the narratives” has developed between senior officials at CMS, especially CMS Administrator Seema Verma, and the leaders of NAACOS— the National Association of ACOs—who have been
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