As Workforce Shortages Intensify, CMS’ Value-based Care Ambitions Hang in the Balance

As Workforce Shortages Intensify, CMS’ Value-based Care Ambitions Hang in the Balance Sarah Cameron

The U.S. healthcare system’s shift from volume to value has been a trudging fifteen-year journey. Despite its potential to reduce costs and improve quality of care, the national movement toward value-based care has been harried by inconsistent guidance, confusion and misalignment among payers and providers, and subsequently mixed success across various payment models. Adoption among providers has been slow – and for good reason.

Success in value-based arrangements requires providers fundamentally and meaningfully transform the way they deliver care. Amidst an unprecedented workforce shortage that continues to ripple across the industry – one that has been boiling for over a decade – many provider organizations don’t have the risk appetite right now to whole-heartedly embrace dramatic changes to reimbursement.

This is especially true in underserved communities across the country, where Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC) are experiencing drastic staffing challenges. According to a survey published last year, 70 percent of FQHCs reported losing as much as a quarter of their workforce in 2021, with 15% of FQHCs losing as much as half of their workforce.

The flight from the workforce is having disastrous impacts everywhere, but nowhere is it more severe than in rural communities, where access to care is already throttled and the patient-to-primary care physician ratio is already a meager 39 physicians per 100,000 people. Health centers are vital institutions in these communities; they provide critical preventive services to geographically distributed patient populations that are more likely to die prematurely from chronic conditions than their suburban and urban counterparts, especially if they are Black or indigenous.

Value-based care could forever transform the way healthcare is delivered and experienced in rural communities, unshackling rural clinicians from the fee schedule and giving them the freedom to provide the level of care people living in rural communities deserve. It is, however, dependent on rural providers’ ability to close gaps in access, improve quality and ensure patient satisfaction.

Absent the ability to bolster their ranks with more clinicians, what health centers need first and foremost to shift to value are technologies that amplify their clinical capacity without further burdening and burning out their core staff.

Tech-enabled services can be the catalyst for widespread value-based care adoption

Providers will find it difficult to embrace value-based care if they do not have tools to enable improvements in care delivery. For value-based care to succeed, clinicians need tech-enabled services that extend their reach, that provide a whole-person view of their patients when they are not directly in front of them, and empower them to proactively manage their patient population. Without these tools, clinicians are operating with blinders on; they cannot see the social determinants of health that make it difficult for their patients to access care, continue their treatment regimens, or otherwise stay healthy. They will be necessary for widespread value-based care to succeed in the future, but they are needed now in rural communities – and healthcare consumers are expecting them.

The Medicare population, specifically, is becoming increasingly segmented as patients age into the program. A brand new Medicare beneficiary may not be a digital native, but they have been living and working with technology for the past few decades. They have grown accustomed to digitization in every other facet of their lives, from banking to shopping to entertainment. They expect technology to be integral to the ways in which they engage, access, and experience care, as well – no matter who they are or where they live.

Patients want to engage more with their care teams, but clinicians are only reimbursed to focus on the patients who are in front of them. Digital health has made incredible advancements in recent years, extending provider organizations’ clinical capacity, providing patients with resources they wouldn’t otherwise have between their visits, and empowering care teams to better manage high-risk patient populations.

Technologies like remote patient monitoring (RPM) devices and chronic care management platforms are giving providers detailed insight into their patients’ health and wellbeing when they’re not directly in front of them. Devices for patients with hypertension and diabetes are providing clinicians with the actionable data they need to make proactive, informed decisions about their patients and enabling incredible quality of life improvements. Despite the obvious benefits this would have for patients and clinicians in geographically-distributed communities, FQHCs and RHCs cannot currently get reimbursed for remote patient monitoring. Their patients not only expect their clinicians to be equipped with innovative technology, they are entitled to it – especially considering the greater access to high-quality care that technology is enabling elsewhere. While some rural health centers do provide tech-enabled services to their patients, those that do rely exclusively on temporary grant funding to do so.

The Centers for Medicare and Medicaid Services continues to double down on its strategy to transition all traditional Medicare beneficiaries to value-based arrangements by 2030, and this past January began the first performance year of the new ACO REACH Model, redesigned to incorporate the administration’s commitment to health equity. Building health equity and accelerating the movement toward value-based care within the next seven years will require a catalyst. Providing health centers in underserved communities with the opportunity to embrace tech-enabled services – to provision their patients with the resources that are available elsewhere – would cushion clinicians, increase access to quality care for patients, and open the doors for widespread value-based care adoption.

Photo: atibodyphoto, Getty Images