Thursday, June 25, 2020

Alternative Payment Models—Victims of Their Own Success? | Health Care Reform | JAMA | JAMA Network

Alternative Payment Models—Victims of Their Own Success? | Health Care Reform | JAMA | JAMA Network

Don McCanne's comments:

Comment by Don McCanne

The policy community has been fixated on alternative payment models (APMs) as a means of incentivizing value-based care - paying for health care based on value rather than on volume. Accountable care organizations (ACOs) were mandated by the Affordable Care Act (ACA), and CMS has introduced several APMs. Although we hear reports of successes of the models, in fact, the results have been very disappointing, with negligible gains usually being offset by deficiencies in the programs. Even this article states, "Individual demonstration projects have not reported significant success."

The authors acknowledge the lack of success, yet they contend that health care spending has plateaued as a percent of GDP, and they want to credit the APMs, as ineffective as they have been, for slowing the overall rate of health care cost increases. In their article they cite psychological changes, peer networks, and control group contamination as explanations for how the unsuccessful APMs could have had a favorable influence on overall spending. You have to read their article to try to understand their explanation.

To top this off, they state, "Given that few, if any, alternative strategies to decrease health care spending are supported by robust evidence, and that alternative payment models have not led to worsening quality or higher spending, these models remain an attractive option that policy makers should exploit." They don't work, but they didn't make things worse they claim, so policy makers should exploit them!

All of this has been a diversion from supporting a model of reform that has been proven to work well, not only for slowing increases in spending, but for correcting many of the other deficiencies in health care financing such as covering the uninsured, eliminating the financial hardship of underinsurance, returning choice in health care by eliminating restrictive provider networks, establishing equitable funding through progressive taxes, and so forth. Of course, that would be the single payer model of an improved Medicare that covered everyone.

The policy community absolutely refuses to get off of the broken value-based-reform hobby horse, and has a tizzy-fit every time single payer Medicare for All is mentioned. This is not new. They've had their turn. It's time for us to dismiss them. We can put together our own team who understand exactly how to establish health care justice for all. Just wish the process didn't have to be political since the United States isn't doing very well there either.