Part 03: What's the role of policy in VBC? Is VBC here to stay? | Eugene Lin, MD (Nephrologist, Researcher)

Summary

This is part three in our conversation with Dr. Eugene Lin, a nephrologist and health economics researcher, to further explore the role of policy in advancing value-based care. In this episode, we discuss how legislation like MACRA has shaped the shift toward value-based care and the critical role policymakers play in aligning provider incentives with patient outcomes. Dr. Lin highlights the future of value-based care as CMS pushes for 100% participation by 2030 and the need for flexibility in care models to better address chronic diseases. We also examine the trade-offs and challenges in balancing cost-saving measures with high-quality care. Need to catch up? Listen to Part 1 and Part 2.

Guest Bio

Eugene Lin is a nephrologist and health economics researcher who focuses on the impact of public policy and federal regulation on kidney care, the provision of dialysis in public and private insurance markets, and transitions of care for patients with kidney disease. He currently serves as an Assistant Professor of Medicine at the University of Southern California (USC). Eugene's research has been featured in high-impact publications such as JAMA, JAMA Internal Medicine, and Health Affairs. His expertise lies in analyzing how value-based care models impact the delivery of kidney care and patient outcomes, making him a key voice in the conversation about healthcare reform.

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Keywords

Value-Based Care, MACRA, Healthcare Policy, Patient-Centric Care, Medicare, Healthcare Delivery Models

Chapters

• (00:20) The role of policy in VBC

• (01:18) The dominant care model in the US

• (02:42) Congress wants VBC, too (e.g. MACRA)

• (05:20) What patients see in VBC arrangements

• (07:37) Getting metrics right (e.g. Fistula First)

• (10:07) Status quo-ism and the enemy of the good

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Takeaways

• Policymakers Play a Crucial Role in Value-Based Care's Success: Health insurance companies are risk-averse and often look to government models, like those implemented by CMS, to guide their approach. Policymakers need to get value-based care right because commercial payers often follow CMS's lead.

• Value-Based Care is Here to Stay: CMS aims for 100% of Medicare beneficiaries to be in value-based care models by 2030. As commercial payers tend to follow CMS's policies, value-based care is likely to become the predominant healthcare delivery model in the U.S.¹

• Legislation is a Key Driver of Value-Based Care Models: The MACRA legislation, which passed with overwhelming bipartisan support, laid the groundwork for many value-based care models. This demonstrates broad political support for moving away from fee-for-service models and toward value-based care.²

• Customizing Care Under Value-Based Models: In value-based care arrangements like the Kidney Care Choices model, nephrologists have more flexibility to tailor care to patient needs, rather than following a rigid, fee-for-service approach. This allows for more efficient, patient-centered care.³

• The Trade-offs in Healthcare Delivery Models: Every model in healthcare has trade-offs, including value-based care. While past policies like "Fistula First" brought positive outcomes, they also had unintended consequences. Policymakers need to refine value-based care models over time, balancing risks with benefits.⁴

• Transparency and Patient Empowerment Are Key: Value-based care emphasizes transparency between providers and patients. Providers should communicate how value-based models impact care delivery, helping patients understand how the system works for their benefit.

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Discussion Topics

• How do you think policymakers can ensure that value-based care models are designed effectively?

• CMS aims for 100% of Medicare beneficiaries to be in value-based care by 2030. What challenges do you foresee in reaching this goal?

• How do you think commercial insurers will adapt their models as value-based care becomes more widespread?

• How can value-based care models enable more personalized, effective care for chronic conditions like kidney disease?

• How should providers communicate the purpose and benefits of value-based care to their patients? Do you have any examples?

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1. The CMS Innovation Center’s Approach to Rebuilding Primary Care: Financing, Equity, Sustainability — CMS.gov

2. MACRA: MIPS & APMs — CMS.gov

3. Kidney Care Choices (KCC) Model — CMS.gov

4. Lee T. Fistula First Initiative: Historical Impact on Vascular Access Practice Patterns and Influence on Future Vascular Access Care. Cardiovasc Eng Technol. 2017 Sep;8(3):244-254. doi: 10.1007/s13239-017-0319-9. Epub 2017 Jul 10. PMID: 28695442; PMCID: PMC5693683.

NKF and the Fistula First Breakthrough Initiative: https://www.kidney.org/nkf-and-fistula-first-breakthrough-initiative