Financial support and monthly revenue incents physicians into value-based care.
Health Plans

Why COVID-19 means more value-based care

August 19, 2020
Financial support and monthly revenue incents physicians into value-based care.
President and CEO

There are reasons to believe one of the impacts of the COVID-19 pandemic will be more physicians choosing value-based care contracts.

In Implications for value-based payment programs: Weathering COVID-19, Julius Bruch, Adi Kumar and Christa Moss of McKinsey & Company wrote, “Through a COVID-19 lens, VBP (value-based payment) programs can support providers in times of uncertainty, such as providing capitated incomes.”

Drs. Amol S. Navathe and Ezekiel J. Emanuel, the physicians who direct the Healthcare Transformation Institute at the University of Pennsylvania, went further, writing in a New York Times op-ed,

Health insurers have advanced billions to doctors and hospitals. But more substantial help is needed. Health insurers should switch from paying doctors for services rendered (the fee-for-service model) to paying them a fixed fee per patient they care for (known as capitation), with adjustments for quality provided and how sick patients are.

During the pandemic, many physicians have confronted epic declines in patient visits, decimating their finances. Even as surge one dissipated in some regions, many patients have remained hesitant to resume regular, preventive care, exacerbating the financial impact of COVID-19 to provider practices.

That’s why health plans like Capital BlueCross, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Blue Cross and Blue Shield of Massachusetts are offering financial assistance to physicians, often tied to participation in the insurer’s value-based care programs.

As Blue Cross NC Chief Medical Officer Rahul Rajkumar wrote,

Our independent primary care practices are the foundation of our healthcare system. These practices have shown to be instrumental in improving outcomes, quality and patient experience.

Unfortunately, the effects of the COVID-19 pandemic have created a financial crisis for independent primary care practices. This is on top of the undervaluing of primary care that existed in our health system before #COVID19.

To address this crisis, Blue Cross NC launched a new program called Accelerate to Value. Our Accelerate to Value program aims to improve the financial stability of participating practices and move to value-based care.

There are two requirements to receive financial support from Blue Cross NC starting in August 2020 and continuing through 2021:

  1. Commit to provide access to care for Blue Cross NC members
  2. Move toward “shared accountability for total cost of care by joining a Blue Premier accountable care organization (ACO) by December 31, 2020.”

At Geneia, we wholeheartedly applaud the efforts of payers to partner more fully with network providers and to support independent physicians remaining independent.

In fact, in our recent white paper, How a Phased Approach to Value-Based Care Works: For Health Plans, Health Systems and their Value-Based Providers, we featured a state-wide health plan* whose current value-based care challenges are:

  • Support independent physicians in value-based care
  • Maintain physician independence to reduce future cost increases

Our four-phase solution includes:

  • Phase 1:    Analytics-as-a-service
  • Phase 2:   Performance reporting for pilot providers
  • Phase 3:   Clinical services
  • Phase 4:   Integrate enterprise platforms with role-based user interface for network providers, medical and care management personnel and member relations

Phased solution: Third-Party Administrator

Like many Geneia clients, this payer is adopting a phased approach to value-based care that prioritizes early wins for providers. Rather than going “all-in” on value-based care, healthcare organizations are increasingly opting for a phased transition, one that involves:

  • Focused solutions addressing immediate needs
  • Early wins and return on investment
  • Internal support and adoption; and
  • Eventual appetite for expansion to enterprise solutions.

To read more about how healthcare organizations are using a phased approach to succeed in value-based care, download the white paper, How a Phased Approach to Value-Based Care Works: For Health Plans, Health Systems and their Value-Based Providers.

*Examples are based on Geneia’s work with clients and prospects. Identifying details have been changed. In some examples, steps have been omitted and/or consolidated to simplify the presentation of this material.