Making Way for Value-Based Care to Improve Outcomes

One of the lessons learned in the wake of COVID-19 is how the removal of outdated regulatory barriers can improve health care delivery and outcomes. For example, the regulatory reform that loosened telemedicine constraints allowed patients to stay connected to doctors, caregivers and family members safely. Although this reform was largely reactive to pandemic-related pressures, more open access to telemedicine technology invites opportunity for innovation, creating long-term positive impacts beyond the pandemic.

To improve outcomes, encourage innovation and deliver the most cost-efficient care, particularly for those with complex chronic conditions, it is essential that health care providers better coordinate patient care. This includes primary care physicians, specialists, hospitals, pharmaceutical companies, medical device manufacturers, pharmacies and others.

More than 120 health care companies, associations and patient advocacy groups, in collaboration with the Healthcare Leadership Council, are advocating for the modernization of regulations that will pave the way for better care coordination, value and outcomes for patients. 

Currently, federal laws and regulations prevent that type of patient-centered collaboration. Measures known as the Stark Law and the Anti-Kickback Statute were created in the era of fee-for-service medicine to protect patients from those trying to manipulate the system for financial gain. In the current transition to more personalized value-based care, these regulations have become outdated and create daunting barriers to the kind of working relationships that foster optimal health outcomes.

This is on the verge of changing. The Department of Health and Human Services (HHS) has developed, with extensive public input, new rules to modernize these outdated laws and regulations and create opportunities for health care professionals and organizations to better collaborate with and care for their patients. There will still be strong protections against fraud and wrongdoing, but the obstacles to patient-centered, value-based care will be significantly alleviated. The proposed updates ensure integrity while allowing success to be measured by the quality of a patient’s outcome, which should always be the ultimate goal. 

These new rules have been submitted by HHS to the Office of Management and Budget for final review and approval. With countless patients poised to benefit from these proposed changes, the health care companies and stakeholder groups actively supporting this effort are asking the administration to bring this critical work across the regulatory finish line. 

This will be another step forward in making value-based care more available to patients.