Leaders from various health care silos discussed potential strategies to increase payment parity at Virginia Commonwealth University’s Virtual Colloquium Addressing Health Equity last week. A 2019 survey from the Virginia Center for Health Innovation found over 55% of surveyed adults in Virginia experienced health care affordability hardships in the last one to two years prior to the survey. It also reported 78% of participants worried about finding affordable health care in the future.
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Panelists included Chris Gordon, chief financial officer at the Department of Medical Assistance Services (DMAS); Beth Bortz, president and CEO at the Virginia Center for Health Innovations; Rebecka Compton, associate medical director of the UVA Family Medicine Primary Care Clinic; and Andrew Barnes, PhD, associate professor of health behavior and policy and VCU. Dr. Joel Bundy, chief quality and safety officer at Sentara Healthcare, moderated the event.
Here are key takeaways from the discussion:
To increase payment parity, there should be more cross-sector communication
From a short-term perspective, Bortz says there is not enough communication between different sectors, such as plans and providers.
For example, DMAS may agree to raise reimbursement rates for primary care physicians (PCP) on the condition their patients have better health outcomes, she said. But PCP may not be able to achieve those better health outcomes if their facilities don’t have the infrastructure — such as properly equipped facilities — to support that level of care in the first place, according to Bortz.
Barnes, drawing on his economic perspective, said the different health care models within the American system — employer-sponsored insurance influenced by Germany’s model, Medicare being similar to Canada, and even Veteran Affairs health benefits drawing from the British model — are not integrated well enough into a universal health care system. Barnes says the country has “not had an appetite” for universal care since President Theodore Roosevelt over a century ago.
“If a public health crisis like we haven’t seen in our country since the Spanish Flu isn’t enough to get structural changes our healthcare system, then I don’t know what is … things we can do that may be more achievable is expand Medicaid further, lower the Medicare age eligibility — those things that can be done. They’re hard to do, but they’re certainly doable.”
Shift the focus to high-value care and data-based models
One barrier to increasing payment equity among Virginians comes from funding an unnecessary amount of care services, said Bortz. With funds stretched between all those different services, that can negatively impact the quality of care a patient receives.
“When I started sharing regional level dashboards for the state, people were shocked that the worst performer, if you will, in terms of low value care, was Northern Virginia. Northern Virginia does not ever think of themselves as the worst performer in Virginia, but they provide a whole lot of unnecessary care to folks and, and that’s just wasted money. It can actually be harmful, and it can lead to cascades of harm.”
Reinvest in the community by restructuring payment flexibility
Following the colloquium’s health equity theme, panelists discussed ways to “incentivize” equity and develop a community investment fund. Barnes brought up a similar initiative in Pennsylvania, which proposed maternity benefit bundles within payer plans to reduce maternal mortality, particularly among disproportionately affected communities.
When asked if DMAS could do something similar, Gordon said it was possible, but not without changes from the General Assembly. He reiterated Medicaid lost much of its flexibility — to establish a community investment fund, for example — due to restrictions the General Assembly imposed in 2018 after an unexpected $500 million spending increase in the budget that year.
“We’ve had to find really unique ways to operate within that really tight box, to the extent possible. Yes, we could do all of those things, but it would require lobbying to the legislature to do that, from the stakeholders.”
Gordon did acknowledge some progress on increasing Medicaid funding in the recently passed special session budget, such as a 12.5% reimbursement rate bump for home and community based services (HCBS).
Focus on data and evidence-based models
Going forward, panelists concurred any payment parity solution would need to be based on gathering quality population data. Compton said:
“You can’t apply the same model of care to Northern Virginia, that you would with Southwest. You might need to infuse Southwest [Virginia] with more [medication assisted treatment] support, addiction medicine support than you do in Northern Virginia.
We have those maps available and we need to really allow folks to be creative and then provide that support in order to do so, and then providing that data back to a provider.”