Value-Based Care in 2024: Anticipating Key Trends and Transformations

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AUTHOR – ATI Advisory


Brian Fuller, Managing Director of ATI Advisory’s Value-Based Care Design and Delivery practice, shared his observations on the evolution of value-based care (VBC) during the webinar, “Value-based care in 2024: Anticipating Key Trends and Transformations.” 

Five Themes in VBC for 2024

Value-based care will continue to accelerate in 2024 

Many organizations are reconsidering their value-based care strategy or implementing one for the first time this year. The time is right, with 13 million Medicare beneficiaries covered by ACO or VBC arrangements in 2023 and aggressive goals by the CMS Innovation Center (CMMI) to have 100% of Medicare beneficiaries in an accountable relationship by 2030. The demand for VBC will only increase as fiscal and demographic factors converge with CMMI’s introduction of new VBC models and Medicare’s projected growth in enrollment. 

Investment in improving primary care is key 

Fuller outlined three aspects of primary care that must be improved if a practice is going to be successful in delivering the value-based care demanded by the healthcare delivery system: access, capacity, and capabilities. Much of the United States, including 77% of rural counties, is considered a primary care desert. While appointment wait times have fallen since 2017, more primary care physicians are opting out of Medicare and Medicaid. Most primary care practices lack VBC capabilities such as site-neutral delivery that would allow them to successfully participate in VBC models. 

Value-based care will involve emergent and legacy players 

Traditional healthcare delivery players such as primary care physicians, hospital systems, and ACOs cannot fully meet the clinical, non-clinical and patient engagement needs of the growing number of beneficiaries embedded in VBC constructs. As a result, emergent players have the opportunity to step into the gaps left by legacy players and play a larger role in VBC efforts. These emergent players, such as community pharmacies and home care providers, form trusted relationships with patients via frequent in-person interactions and community engagement and can close quality care gaps, improving transitional care between inpatient and home settings among other potential roles. 

Specialty care is becoming increasingly important for addressing the needs of complex care populations 

Since 2009, outpatient care for Medicare beneficiaries has shifted increasingly toward specialty visits without a corresponding shift in primary care visits. This increased utilization of specialty care creates an opportunity to more meaningfully incorporate specialty care into VBC models. CMS released two RFIs last summer to evaluate these opportunities, and private equity investment has increased in specialty care areas such as dementia and chronic kidney disease. 

Medicare Advantage has the opportunity to be a driver of innovation in value-based care 

Medicare Advantage (MA) has long offered more flexibility and design incentives than traditional FFS Medicare; however, Fuller has identified certain market factors that he expects to increase pressure on MA plans to innovate in 2024. These factors include the blurring of lines between payer and provider, the increased financial pressures on MA plans via the RADV rule, and the removal of FFS adjusters. 

Fuller touched on several other trends to watch in 2024: 

  • Episode-of-care and bundled payments driving focus and flexibility across VBC payment structures 
  • Post-hospital throughput challenges intersecting with VBC efforts 
  • Medicaid emerging as a new frontier in VBC innovation, particularly for complex and vulnerable populations 
  • Integration of health equity and SDOH in VBC models requiring new clinical, operational, and financial constructs 

Fuller closed the webinar with a discussion on how having a well-defined and refreshed value-based care strategy will set organizations up for success in addressing today’s market dynamics and opportunities. 

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