MACRA, price transparency, value-based care & more — 5 trends for 2018

Analysts with Washington, D.C.-based consulting firm Avalere hosted a webinar Jan. 4 on the top trends to watch in 2018.

Here are five outlooks from the experts on what to expect this year regarding value-based payment models, ACOs, price transparency and federal programs.

1. Medicare Access and CHIP Reauthorization Act. Physicians will increasingly try and figure out how to get bonus payments under MACRA, Josh Seidman, a senior vice president at Avalere, said. Many physicians are also going to move into alternative payment models as more providers assume risk, he said.

2. Value-based payments. While the pace has slowed in the transition to value-based care at the federal level, Mr. Seidman said the overall trajectory remains intact. Providers are beginning to find success under MACRA, and about half of ACOs that participated in value-based programs for the past three years have begun to reap savings.

"As they grow more comfortable and get better reporting capabilities and more creative relationships with other providers, they're finding it easier to have some success," Mr. Seidman said.

As far as ACOs, Mr. Seidman said physician-led ACOs have performed better than traditional ACOs under the Medicare Shared Savings Program. He said those types of alignments will continue, as well as new types of partnerships.

3. Medicare Advantage. There is a huge growth opportunity for health plans in the Medicare Advantage realm, Elizabeth Carpenter, a senior vice president at Avalere, said. On the provider side, Ms. Carpenter expects more providers' Medicare patient volume to come from Medicare Advantage members. This could mean new value-based contracting opportunities for providers.

4. Federal waivers. CMS Administrator Seema Verma is a "waiver expert," Ms. Carpenter said, and expects CMS will grant new flexibilities through waivers. Components of waivers will focus on Medicaid work requirements, wellness programs and initiatives to give beneficiaries more "skin in the game," she said.

5. Price transparency. The pharmaceutical supply chain is complex, often leaving consumers in the dark as payers and intermediaries negotiate net price discounts, Mr. Seidman said. Nationally, payers and health IT companies will continue to try and provide more price transparency to patients, he said. In addition, providers may increasingly share discounts directly with consumers.

On the state level, Ms. Carpenter said she expects more states to pursue price transparency legislation.

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