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Trump May Slow, Not Stop, Transition to Value-based Care

Analysis  |  By Debra Shute  
   November 17, 2016

Despite uncertainty around the GOP's promise to repeal and replace the Affordable Care Act, MACRA and risk-based payment models could remain intact, says one public policy expert.

Just weeks after physicians received a clearer roadmap for implementation of MACRA, the election of Donald J. Trump has potentially thrown in a detour.

With few details available about the President-elect's plans on healthcare reform, Chet Speed, JD, LLM, vice president of public policy for the American Medical Group Association shared some insights into early response to the election among AMGA members.

The following transcript has been lightly edited.

HealthLeaders Media: What have AMGA members been saying so far about the implications of Trump's election?

Chet Speed: Outside of saying, "Can you believe it's happened?" members are beginning to digest how a fairly aggressive healthcare agenda may impact their operations.

Three-fourths of our members have medical groups, hospitals, post-acute facilities, or health plans—and the impact on each is going to be different.

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They're doing a lot of thinking right now, and everything is unpredictable. The concrete [fact] is that Trump campaigned on repealing the ACA. The unknown is what the ACA will look like once it's re-litigated in 2017.

HLM: How might the new administration affect the healthcare industry's transition to value—and MACRA in particular?

Speed: Some of the early thinking, especially for smaller practices and community hospitals who haven't really gotten ready for value yet, is that they're going to slow their efforts in terms of integrating with other practices and looking at how they can save money on the hospital side to work under a value budget.

With the tremendous uncertainty over the ACA repeal, the appetite for the value transition will probably slow for a great swath of the industry.

However, a lot of our members are still moving forward because they've already enrolled as a Next Generation ACO, the Medicare Shared Savings Program, or they have commercial contracts with some sort of value component.

As far as MACRA is concerned, it's still statute, which reflects that Congress and CMS want to move ahead on this thing called value.

HLM: Historically, private payers follow the government's lead. Do you think we'll see a shift in that pattern?

Speed: It's interesting. Commercial payers do follow Medicare, typically, but we have conflicting ideas to consider.

On the one hand, when I think about the risk survey we conducted last year, it was clear that our members were engaging with commercial payers on commercial ACOs more than federal ACOs because, frankly, with commercial payers the negotiations tend to be easier.

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Commercial payers aren't regulating them like CMS, so they just want to create products that make sense for both sides.

On the other hand, I wouldn't say the commercial payers are offering a lot of risk products in the market right now. I think one of the issues our members have is that commercial payers aren't offering enough products to continue with this value transition.

So as far as the value proposition, all providers and payers have to get together and decide how both are going to be successful in risk, because I think that transition was slowing even before Trump was elected.

The on-demand HealthLeaders Media webcast, How the 2016 Election Will Affect the Future Landscape of Healthcare Payment and Policy, offers more information on healthcare policy, payments, and politics.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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