What CEOs think about MACRA, value-based care

Emily Rappleye (Twitter) - Print  | 

Health system CEOs agree the healthcare industry is moving to value-based care, but it's much slower than they expected, especially in the commercial payer market, according to a report from Deloitte.

The report is based on interviews conducted in May 2017 with 20 CEOs from health systems with at least $1 billion in annual operating revenue. The CEOs came from a variety of organizations, including nonprofits, faith-based nonprofits, academic medical centers and children's hospitals.

Deloitte found the majority of the CEOs felt the slow pace of value-based care adoption meant providers would be forced to straddle two payment models with opposing incentives for longer than expected. The CEO of one large nonprofit health system told Deloitte: "[Value-based care] is a major [concern], [but] it is moving backwards. We can’t find payers, whether it be insurers or businesses, who seem tremendously interested in moving in that direction. As a large integrated delivery system, I could be stuck between a Medicare payment system that rewards outcomes, and a commercial payment system that is stuck in a fee-for-service world. That makes constructing and managing and leading an organization like this challenging as the economic incentives will essentially point to polar opposite directions."

Aside from the majority of leaders from AMCs, most of the CEOs did not consider population health management a major concern yet, largely because true population health models are not yet available. That said, the general consensus among CEOs was that the Medicare Access and CHIP Reauthorization Act would promote population health management. "You can really combine MACRA and population health. They are mutually overlapping; that is, MACRA is simply a form of population health. It really is our ability to deliver healthcare outside the four walls of our medical centers and it moves away from hospital-based care," said a CEO of a large AMC.

Most CEOs reported concerns about physician preparedness for MACRA. As such, many reported ramping up conversations about population health with physicians.

Read the full report here.


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