Andrei Gonzales Advocates for Experimenting With New Payment Models

One of the positive effects of the Affordable Care Act’s shift to value-based care is that providers and payers are experimenting with a number of new models, so the successful ones are being implemented on a larger scale, according to Andrei Gonzales, director of value-based reimbursement initiatives at McKesson Health Solutions.

Transcript (slightly modified)

What has the US health system gotten right in the move to value-based care?

Well, I’d say one of the things that the health system has gotten right in the move to value-based care is really an effort this time that would be different from what we saw 20 years ago with HMOs [health maintenance organizations] and some of the struggles that we had there. So this time the Affordable Care Act mandated that models be experimented and investigated, and as models show promise, that they be scaled up. So what we’ve been going through in the last few years is a period of investigation where we have small scale pilots that have been done and studied, and the ones that are successful are moving on to scale.

And an example would be the Comprehensive Care for Joint Replacement Model by Medicare. That’s a mandatory program that was preceded by the bundled payment for care improvement initiative, which was a voluntary program, and it just shows an example of how CMS through the Affordable Care Act is experimenting—as experiments show promise, then models are scaled up.

We see the same thing through accountable care organizations, shared risk models, patient-centered medical home models—so there are a lot of models being tested. Models that aren’t working, for instance, some of the shared risk models that use kind of self-benchmarking instead of regional benchmarking are being abandoned because they’re not really working for providers to be able to show consistent performance and benefit over time. So that’s one of the things that I think is a lot different and is working well, is that this period of experimentation has really shown some models that have promise and now those models are being scaled.