Tag: Value-Based

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Health Law Highlights

Using A Value-Based Enterprise to Integrate Specialists and Primary Care: Taking Value-Based Care to the Next Level

Summary of article from Nelson Mullins Riley & Scarborough LLP, by Mike Segal, Edward White:

Within the value-based healthcare model, the majority of medical expenses come from specialist sectors operating under traditional fee-for-service payment models. A potential solution to this challenge could be the implementation of a Value-Based Enterprise (VBE) that promotes mutually beneficial contractual relationships between primary care providers and specialists in a low-risk regulatory environment. Thanks to new regulations under the Stark Law and Anti-Kickback Statute, a VBE can act as an “Innovation Center,” allowing healthcare professionals to develop their own initiatives aimed at providing high quality, cost-efficient care. It is proposed that Primary Care Provider (PCP) Risk Arrangements embrace patient attribution, apply for capitation payment arrangements, contract with high-quality specialists, and pay these specialists under a value-based framework. This system can help control total care costs and improve patient outcomes.

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Health Law Highlights

Tame The Private Equity Beast By Shifting Its Focus To Value-Based Care

Summary of article from Health Affairs, by Ken Terry:

The influence of private equity (PE) firms on the healthcare industry has lead to several concerns, including reduced quality of patient care, increased expenses, and potential economic instability. However, PE firms could also play a constructive role in healthcare reform if their investments were directed towards helping entities transition to value-based care (VBC). Tax incentives could motivate PE investments in VBC-oriented entities (VOEs). Policy changes, such as extending holding periods for health assets, creating escrow accounts for failed strategies, and establishing joint liability between PE firms and their owned companies, could motivate PE firms to focus on primary care and reduce healthcare waste.

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HHS Proposes Modifications to the HIPAA Privacy Rule to Empower Patients, Improve Coordinated Care, and Reduce Regulatory Burdens

The proposed changes to the HIPAA Privacy Rule include strengthening individuals’ rights to access their own health information, including electronic information; improving information sharing for care coordination and case management for individuals; facilitating greater family and caregiver involvement in the care of individuals experiencing emergencies or health crises; enhancing flexibilities for disclosures in emergency or threatening circumstances, such as the Opioid and COVID-19 public health emergencies; and reducing administrative burdens on HIPAA covered health care providers and health plans, while continuing to protect individuals’ health information privacy interests.

Source: HHS Proposes Modifications to the HIPAA Privacy Rule to Empower Patients, Improve Coordinated Care, and Reduce Regulatory Burdens

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HHS Finalizes Highly Anticipated Final Rules Amending AKS and Stark Law Regulations, Part III: Value-Based Arrangements

A value-based arrangement is an arrangement entered into between a value-based enterprise (VBE) and one or more of its participants, or among VBE participants in the same VBE, for the provision of one or more value-based activities for a target patient population. The final rule defines a VBE participant as an individual or entity that engages in at least one value-based activity as part of a value-based enterprise, other than a patient acting in their capacity as a patient.

For purposes of the OIG’s new safe harbors, a VBE is two or more participants that: (1) are collaborating to achieve at least one value-based purpose; (2) are each a party to a value-based arrangement with the other (or at least one other participant in the same VBE); (3) have an accountable body or person responsible for financial and operational oversight of the VBE; and (4) have a governing document describing the VBE and how its participants intend to achieve the VBE’s value-based purpose(s).

The size and structure of a VBE can vary greatly from a large network of providers and suppliers; a separate legal entity, like an Accountable Care Organization (ACO); or just two providers contracting together to form a value-based arrangement.Finally, a value-based purpose is (1) coordinating and managing the care of a target patient population; (2) improving the quality of care for a target patient population; (3) appropriately reducing the costs to, or growth in expenditures of, payors without reducing the quality of care for a target patient population; or (4) transitioning from health care delivery and payment mechanisms based on the volume of items and services provided to mechanisms based on the quality of care and control of costs of care for a target patient population.

Source: HHS Finalizes Highly Anticipated Final Rules Amending AKS and Stark Law Regulations, Part III: Value-Based Arrangements | Mintz