Policy guidance provides strategies for the transition to value and payment-based health care

Statement highlights:

  • The American Heart Association supports a person-centred, equitable, and streamlined Value-Based Payment (VBP) system of care that seeks to improve equity, the patient and provider experience, and the health of individuals and populations while controlling costs.
  • Identifying and improving clinician understanding of value-based payment program design and best practices enhances informed decisions to engage and successfully engage in these models.

Hmbargoed up 4:00 a.m. ET / 5:00 a.m. ET, Monday, July 10, 2023

DALLAS, July 10, 2023 — The American Heart Association, a global force for longer, healthier lives for all, is calling for a move away from the current US health care payment system, which relies primarily on fees-for-service, toward a pay-as-you-go system. value (VBP). The VBP system is human-centered, equitable, and coordinated and seeks to improve outcomes and experiences for patients and clinicians, while controlling costs.

Health care payers, including the American Centers for Medicare and Medicaid Services (CMS), employers and health insurers, are increasingly adopting new payment models based on quality of care and cost of care. In the American Heart Association’s new policy statement, “Value-Based Payment for Physicians Who Treat Cardiovascular Disease,” the association summarizes the current landscape of VBP for cardiologists and outlines recommendations for increasing its adoption. The new policy statement, published today in the association’s leading peer-reviewed scientific journal, Rotation.

In the traditional fee-for-service system, physicians are paid based on the number of services rendered, which does not include consideration of quality of care, patient outcomes, or use of resources. In the VBP system, the focus is on improving quality and results.

“Value-based models of care delivery and payment hold promise for better patient outcomes and lower costs,” said Karen Gwent Maddox, MD, MPH, FAHA, vice chair of the policy statement, and member of the American Heart Association. CC and Assistant Professor of Medicine at Washington University in St. Louis in St. Louis, Missouri. “Value-based programs represent an important but unrecognized opportunity to improve physician experience, efficiency, quality and value of patient care.”

The new policy statement emphasizes the critical need to frame VBP programs as they expand, prioritizing equity and leveraging VBP models to improve health outcomes among populations at high risk of chronic disease.

Policy statement recommendations for value-based care delivery and payment models include:

  • integrate person-centered process and outcome quality measures;
  • improving how clinicians evaluate cost;
  • Include employment status and social risk factors in risk modification methodologies;
  • promoting flexible funding for comprehensive team-based care and innovation;
  • ensuring that clinicians have the resources and capabilities to implement best practice; And
  • Alignment of value-based sponsorship and payment programs across public and private payers.

The statement also identifies key themes for the future of successful VBP programs and payment reform for cardiovascular care:

  • VBPs must move away from a fee-for-service model toward more flexible, population-based models that allow innovation in care delivery.
  • VBP models must find the right balance between improving quality and reducing the cost of care, with quality improvement being the dominant construct.
  • Promoting health equity is central to improving the quality of care. Every VBP design should include redress measures to help avoid unintended consequences.
  • VBPs must collaborate with physicians to ensure they receive adequate support to provide high-quality care.

The recommendations align with the Innovation Center CMS strategy update published in October 2021 to promote “a health system that delivers equitable outcomes through high-quality, affordable, and person-centred care.” In collaboration with the Duke-Margolis Center for Health Policy, the association expressed support for the CMS recommendations in a 2022 white paper addressing improving heart health through value-based payment.

The American Heart Association’s policy statements put the association on issues that will affect cardiovascular health and mortality, guide our advocacy work at all levels of government, allow us to support the important work of others, and inform policymakers, practitioners, healthcare professionals, researchers, the media, and the public.

Co-authors and writing group members are Chair Paul Heidenreich, MD, MS, FAHA; Alexander T. Sandhu, MD, MA, vice president; William Borden, MD, FAHA; Stephen A. Farmer, MD, PhD; Michael Hu, MD, PhD, FAHA; James Hammond, MD, MPH; Rishi K. Wadhera, MD, MPP, M. Phil. ; Jason H. Wasfy, MD, M.Ph.; Kathy Bega, MSN; Edwin Takahashi, MD; Khamal d. Misra, MSN; and Janae Johnson, MPH Authors’ disclosures are included in the manuscript.

The association receives funding mainly from individuals. Foundations and companies (including pharmaceutical companies, device manufacturers, and other companies) make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing scholarly content. Revenue from pharmaceutical and biotechnology companies, device manufacturers, health insurance providers and general financial information for the association is available here.

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are committed to ensuring equitable health in all communities. By collaborating with many organizations and supported by millions of volunteers, we fund innovative research, advocate for public health and share life-saving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us at heart.org, Facebook, and Twitter or by calling 1-800-AHA-USA1.

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For media inquiries: 214-706-1173

Suzette Harris: 214-706-1207; Suzette.Harris@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

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