VALUE-BASED CARE UPDATE
dreamstime At the APG Colloquium 2020, Medical Group
Leaders Parse the Value Landscape The shift from volume-based to value-based payment and delivery systems is neither simple nor linear, as medical group leaders agreed in a panel discussion held at the virtual APG Colloquium in November By Mark Hagland
O
n November 17, leaders of the medical group association America’s Physician Groups (APG) discussed the future of the value movement in U.S. healthcare at the APG Colloquium 2020, which was held virtually this year. Don Crane, president and CEO of APG, led a discussion entitled “Value Movement: Smooth Sailing? Or Clouds on the Horizon?” He was joined by Niyum Gandhi, executive vice president and chief population health officer at the Mount Sinai Health System in New York City; David Joyner, CEO of the Hill Physicians Medical group, based in the
San Francisco suburb of San Ramon; and Robert E. Matthews, president and CEO of MediSync, a Cincinnati-based con- sulting firm focused on medical group management.
APG’s Crane initiated the session by asking how panelists see the overall landscape for the value-based payment and care delivery movement. “I do see continued operation of capitated models, and getting away from fee-for-service medicine,” Hill Physicians’ Joyner said. “You see it in Medicare Advantage; also in global payments with professional facilities; and you also see it in MediCal [Medicaid in California]. On the other
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hand, putting a shared-savings program on top of a fee-for-service system is a little bit like putting broccoli on top of a hamburger,” Joyner said, referring to the Medicare Shared Savings Program sponsored by the Centers for Medicare & Medicaid Services (CMS). “Outside of MA, we have a massive amount of fee-for-service reimbursement. So the marketplace is very mixed.” Joyner went on to add that “The other thing is that value is linked to outcomes, quality, cost of care. And reimbursements are more linked to the leverage that a provider has than the actual results; and until that changes, we won’t have
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