Pursuing the Holy Grail of Value-Based Care? Penn’s LDI Says Head This Way.

Whether the cup of value-based care is half empty or half full may depend on your point of view. But the grail certainly isn’t full. Some of the leading lights at the Leonard Davis Institute (LDI) of Health Economics at the University of Pennsylvania have released recommendations to hasten the volume-to-value healthcare transformation.

Among their more provocative suggestions is increasing the number of valued-based programs that would be involuntary. One of the authors, Hoangmai H. Pham, M.D., M.P.H., said during a webinar in March that there had been an “undue skittishness about deploying mandatory models.”

Another author, Ezekiel Emanuel, M.D., Ph.D., discussed the investment of resources and time it takes providers to change to healthcare that rewards quality and lowers costs. “Groups are going to be resistant and reluctant to do that just because of the time — forget the money — just the time and the necessary work that is required,” Emanuel said. “If you have a mandatory model, it takes people over that potential energy barrier.”

Pham and Emanuel were top-ranking health officials in the Obama administration. Rachel M. Werner, M.D., Ph.D., executive director of LDI, and Amol S. Navathe, an assistant professor at Penn’s Perelman School of Medicine and a senior fellow at LDI, are also authors of the 18-page white paper about the future of value-based payment.

Some of their other recommendations for CMS include slowing down the introduction of new programs, designing the models to simplify administration and taking a balanced, “portfolio-based approach,” which would mean funding a select number of programs with differing goals. They also say that CMS should favor programs with two-sided risk. “Programs that use two-sided risk (i.e., shared savings and losses) appear to have the greatest impact,” according to the white paper.

Healthcare disparities have been on the periphery of ACOs, bundled payments and other programs that CMS (and private payers) have used to advance value-based care. One of the main recommendations from the LDI leaders is to make them central. Some of their specific suggestions include the addition of quality metrics for efforts aimed at addressing healthcare disparities and targeted funding for the care of populations with social risk factors.