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Where are Medicare value-based payment models headed after COVID-19?

By: Rich Daly

DataGen was recently featured on

The COVID-19 pandemic has opened up new opportunities and created new challenges for providers participating in various Medicare value-based payment (VBP) models, industry advisers say.

CMS on June 3 unveiled a range of generally worded changes to various models, aiming to limit financial risk for provider participants during the pandemic and related shutdowns. But hospitals and other providers already are looking beyond the pandemic at how their performance in the models may be drastically affected by COVID-19-related Medicare policy changes, constraints on provider capabilities and evolving patient attitudes.

The suspension of downside risk for many of the models was necessary, in part, because many patients have been either unable or unwilling to seek needed preventive care, and so their conditions worsened, sometimes catastrophically. Without changes, many provider participants would have been facing steep penalties as a result.

Patient reluctance to obtain needed care due to COVID-19 fears is likely to continue after the pandemic and the temporary grace period offered by CMS, said Andrei Gonzales, MD, associate vice president for Change Healthcare.

“It’s going down, but the public perception is still, ‘Avoid the hospital,’” said John Kalamaras, business intelligence analytics manager at DataGen.

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