Do healthcare CEOs agree on whether VBC and MA actually save money? – MedCity News

Value-based care and Medicare Advantage are often touted as two of the most promising health care strategies for controlling costs, but industry leaders can’t really say whether they actually work.

During a recent discussion hosted by a consulting firm rule of threehealthcare executives have questioned whether these models actually save money. Some believe that value-based care and Medicare Advantage will soon deliver on their promise of lower costs, and others believe they have failed when it comes to achieving their goal.

Michael Meucci, CEO of the health data platform Arcadiasaid value-based care is entering an era where it must truly demonstrate impact.

In his eyes, the industry needs to move beyond coding optimization or star ratings and instead use value-based models to reduce costs by combatting fraud, waste and abuse. He sees it as a real opportunity.

“There are a number of healthcare costs that are simply bad actors, and value-based programs monitor that data more regularly than anyone else,” Meucci said.

Health Risant CEO Jaewon Ryu agreed, saying that value-based care has not yet fully realized its potential, but remains the most promising approach to improving outcomes and managing population health.

Meucci also pointed out that some payers reducing enrollment in Medicare Advantage plans could ultimately strengthen their margins and encourage more innovation in the area of ​​cost containment.

As insurers exit markets or benefits become less profitable amid increased utilization and tighter reimbursements, remaining plans may be forced to operate more efficiently, potentially creating more room to invest in new care models and technologies.

And Ryu noted that ongoing changes to Medicare Advantage, including reevaluation of supplemental benefits, could reshape the program as the nation’s population ages.

He said it’s possible these changes will make the program more sustainable and responsive to patients’ needs.

Another speaker — Dan Mendelson, CEO of Morgane Health — took a favorable view of Medicare Advantage, noting that it now covers more than half of America’s seniors and serves as a major platform for innovation, including the deployment of clinical AI tools.

He believes Medicare Advantage could ultimately surpass value-based care in terms of impact.

But Meucci stressed that there is still no consensus on why the touted value of Medicare Advantage has not translated into lower spending. He said the industry hasn’t yet found a good answer as to why Medicare Advantage is still more expensive than traditional Medicare.

As a self-proclaimed “money guy,” Shawn Gremminger has pushed back hard against the notion that value-based care or Medicare Advantage actually bends the cost curve. He is CEO of National Alliance of Healthcare Purchasing Coalitions.

Gremminger argued that the fact that Medicare Advantage continues to cost more than traditional Medicare raises doubts about the overall effectiveness of value-based payment models.

“I haven’t seen any evidence that value-based care actually saves Americans money,” he noted.

Instead, Gremminger believes employers will increasingly rely on direct contracting with providers, which he described as a simpler, more transparent method to reduce costs and have more influence over health care purchasing.

For now, it remains an open question whether value-based care and Medicare Advantage will significantly reduce costs or simply redirect spending.

Photo: MirageC, Getty Images