Presidential Pitch IV: Strengthen Medicare Value-Based Programs

February 22, 2021 · Matt Brock

This is the last in our series of recommendations for the Biden Administration as it takes the reins of the nation’s health care policy. It’s certainly not the least.

Presidential Pitch: Improve Value-Based Programs

As you likely know, we’re big proponents of strong value-based programs that encourage and reward high quality care. And we see the Medicare Advantage (MA) Star Ratings program as the example for how appropriate financial incentives and quality measurement can lead to better care, better choices and better outcomes.

NCQA, of course, strongly supports value-based purchasing programs, the vast majority of which rely on our Healthcare Effectiveness Data and Information Set (HEDIS®) for measurement. Still, and as always, we see opportunities to improve these programs and the data that informs them.

We believe program design is pivotal. New programs should expand from clinician-level to add and encourage full systems of care. We also believe carrots should be balanced with sticks—down-side risk or penalties for poor performance.

Digital Makes Stronger Data

Now Data and Digital. If you’re going to reward value, it had best be based upon data you can trust. These programs only succeed when the data are validated and audited, the programs’ measure of success is clear and meaningful, and performance is comparable. Opportunities abound as a digital quality system evolves. We see room for more accurate, effective data, reducing the clinician burden and ultimately leading to improved efficiency and saved resources.

There is much more to our recommendations for value-based programs and their role in the country’s quickly evolving health care system. In fact, we have some specifics for:

• The Medicare Advantage Star Ratings (Include strong process measures).
• Patient experience measurement (Important, but don’t under-value outcomes).
• Merit-based Incentive Payment System (Bring specialty providers into value-based programs).
• The Centers for Medicare and Medicaid Innovation (CMMI) Programs (Multiple opportunities).

All of those bullets are over-simplified. So, we recommend you read the full set of recommendations.

We look forward to working with the Biden team. Together, we can build better value-based purchasing programs that reward (and hold accountable) every level of care delivery.