Exploring Value-Based Care with Margaret Braxton
Below is an excerpt of the full interview conducted with Margaret Braxton. Download the PDF now for the full article.
Key Takeaways
Geographic Proliferation of Value- and Risk-Based Reimbursement Models – Why Some States and Not Others?
- Markets controlled by hospital systems are likely to be slower to meaningfully adopt value-based care models given that: (i) shifting large health system and their associated provider networks is a heavy lift and arduous task and (ii) value-based care reimbursement models are often at odds with hospital legacy revenue models and are perceived to leave hospitals with less potential upside.
- Markets with robust independent providers are more likely to experience consolidation that is, in turn, conducive to more organized and viable adoption of value-based care models.
- Markets with heavy Medicare Advantage patient populations are also likely to see meaningful migration to value- and riskbased models.
Views on the Florida Value-Based Care Landscape
Adoption of value-based care models in Florida has been driven by:
- Heavy Medicare Advantage population
- Legacy of more flexible payer policies in terms of required member thresholds to adopt value- and risk-based models, as well as more appetite for partnering with multiple parties within the same market & line of business
Heavy competition in Florida leaves smaller payers at a disadvantage – lacking in membership critical mass. Expect some of these smaller players to leave, or invest less in, the Florida market as they experience challenges achieving success in the market. Oscar Health is one recent example of a payer leaving the Florida market.
One of the key reasons is that it is often more difficult for true progress toward value-based care to play out where you have health system laden markets.
