The World Health Report represents a significant opportunity to draw on the lessons of the past, consider the challenges that lie ahead, and identify substantial avenues for health systems to narrow the intolerable gaps between aspiration and implementation. It is insurmountable to imagine or discuss the future of healthcare without hearing the diction “transition to value” and “value-based care.” Experts are keen on discussing future refinements to models being tried by the Centers for Medicare and Medicare Services, insurers and providers. However, the basic advancements are being overlooked.
The future payment models will incorporate drug expenses. Spending on outpatient drugs is only occasionally incorporated into risk-based contracts. This isn’t because spending on pharmaceuticals doesn't make a difference. Medicare Part D covers 1.5 billion drug events every year, as instructed by CMS. For chronic conditions like coronary illness and diabetes, medical management can keep the patient fit and healthy and ultimately reduce the high-cost events. Given the current focus on pharmaceutical costs, it's unavoidable that the industry will still witness models fuse tranquilize spending to advance extensive and proficient consideration.
Although there are operational difficulties in incorporating outpatient treatments into risk-based models, medication management is imperative to keeping patients healthy. Moreover, while numerous doctor-controlled medications are incorporated into current models, CMS as of late, proposed changes which would fundamentally rebuild the manner in which Medicare pays for these medications.
Medicare advantage plays a crucial role in payment and delivery innovation and covers about 33 percent of Medicare population, thus expected to reach 40 percent by 2027. In early 2018, CMS has announced additional flexibilities to the health plan that covers expanded benefits, non-medical benefits, and promotes wellness more broadly. This has led to seeking more skeptical risk-based agreements with healthcare systems and providers. Medicare spends nearly $60 billion yearly on post-acute care, which speaks to more than 15 percent of aggregate Medicare fee-for-service spending; however, post-acute care often doesn’t get the attention it deserves. Optimizing post-acute care will be essential to succeed in risk-based contracting. Since the past decade, value-based care has become a frequent topic in the health policy sector.