Real-world evidence can be a driving force behind value-based payments, but the healthcare system has a ways to go before that is a reality, experts said.
Mark McClellan, former commissioner of the Food and Drug Administration and former administrator of the Centers for Medicare & Medicaid Services, said that the industry still hasn’t gotten to the root of the problem: Healthcare in the U.S. is still not effectively configured—with or without data—to proactively identify and meet patient needs.
“We’ve got a healthcare system that’s really good at taking care of people who can afford it when they get sick,” he said. “We don’t have a healthcare system that’s good at identifying who’s at risk before they come in.”
McClellan was joined on the panel hosted by the Bipartisan Policy Center by former FDA commissioners Andrew von Eschenbach, M.D., and Robert Califf, M.D., to discuss how data can promote payment and regulatory reform.
Though the transition away from fee-for-service remains slow, it’s not for lack of investment, McClellan said. Healthcare organizations from across the spectrum, including payers and providers, have invested plenty in technology, but there remains a dearth of population-based models harnessing that investment.
Califf said some regions, like his home state of North Carolina, are taking the lead on harnessing population health and outcomes-based models. In the Old North State, the state Department of Health and Human Services is driving Medicaid to adopt a two-sided risk model, putting greater onus on providers and managed care companies operating there to focus on value.
McClellan also noted CMS’ overhauled accountable care organizations, which seek to push participants to take on greater risk more quickly.
Though there is promise, plenty of barriers remain to a more rapid expansion of such models, the panelists said.
For example, data privacy laws can prevent payers and providers from sharing real-time data, a wealth of which is available, for population health initiatives. McClellan said there is room to get patients more comfortable with the idea of increased data-sharing, but the industry isn’t quite there yet, either.
Plus, regulations built on a fee-for-service model can prevent value-based payment models from reaching their full potential, such as the Stark Law and anti-kickback statutes that, while effective in a volume-based approach, can further hinder data-sharing and collaboration between participating providers and payers.
“I think it’s still early days in terms of moving away from the volume-based approaches to payments to ones that are really going to enable different approaches to care,” McClellan said.
A video of the full event is embedded below: