Hill Briefing Addresses Barriers to Success in Value-Based Care

Tom Conniff, assistant general counsel at Johnson & Johnson
Tom Conniff, assistant general counsel at Johnson & Johnson

The Healthcare Leadership Council (HLC) hosted a briefing on the benefits of value-based care, and how certain modernizations of the system would improve patient outcomes.  Mary R. Grealy, HLC president, moderated the event and the panel was made up of experts from Johnson & Johnson, Fairview Health Services, and Crowell & Moring LLP on behalf of Medtronic.

Troy Barsky, partner at Crowell & Moring LLP, spoke on behalf of Medtronic.  He provided an overview of fraud and abuse safeguards in the healthcare system such as the Stark Law and Anti-Kickback Statute.  Barsky explained how outdated these laws have become and how they hinder the goal in value-based care of aligning incentives for better care coordination.  He pointed out that the current laws were written for a traditional fee-for-service setting, and not compatible with rewarding value or allowing for flexibility in collaborative arrangements.

Tom Conniff, assistant general counsel with Johnson and Johnson, went into greater detail describing value-based arrangements and stated that unlike in the fee-for-service system, manufacturers are held accountable for the performance of their products.  Reforming fraud and abuse laws, he said, will allow medical device companies to tie rebates to clinical outcomes and offer more ancillary services that result in sustained patient health.

Trudi Trysla, chief legal counsel for Fairview Health Services, agreed with her fellow experts that the regulatory frameworks for Stark and Anti-Kickback are misaligned.  She provided examples of how hospitals providing free services to patients such as transportation, health coaching, or financial aid for medication can trigger fraud and abuse penalties.  Trysla said that many non-profits wish to improve the health of the communities they serve, however the laws and associated fines are barriers to ensuring that the full scope of patients’ needs are met.