Hill Briefing Explains Need to Eliminate Barriers to Value-Based Care

Robert Wyllie, M.D., Chief Medical Operations Office at Cleveland Clinic.

The Healthcare Leadership Council hosted a briefing on Capitol Hill that focused on how the modernization of fraud and abuse laws within healthcare would enable a more successful utilization of value-based care models.  An expert panel provided examples of barriers and offered real-world examples illustrating how changes would bring about more cost-efficient and higher quality healthcare.

Troy Barsky, a partner at Crowell and Moring LLP, represented Medtronic on the panel and addressed the fundamental objectives of the Stark Law and the Anti-Kickback Statute (AKS).  Speaking for the medical device industry, he noted that AKS laws were written for a time in which traditional reimbursement models incentivizing volume – not value – were being used.  AKS laws are not systemically waived for collaborations between industry, provider, and payers that would improve outcomes and lower costs.  Mr. Barsky concluded that new value-based payment safe harbors would benefit patients and consumers.

Leigh Anne Leas, the U.S. country head of public policy at Novartis, explained how the pharmaceutical company has been engaging in different pricing models that support the shift from volume to value, and tie price to performance.  She pointed out that if value-based contracts involve data analysis or medication adherence, AKS laws present a challenge to progress in linking cost to patient outcomes.

Robert Wyllie, M.D., Chief Medical Operations Office at Cleveland Clinic, discussed post hospital care and discharge patterns.  He showed how the options available, whether they be home care, skilled nursing facilities, rehab hospitals, or long-term acute care hospitals, were not chosen for efficiency and quality purposes, but rather to comply with current regulations.  Dr. Wyllie stated that the Stark and AKS regulations limit the continuity of care and do not encourage the quickest, most effective road to recovery for patients.