Three lessons learned from the past year

It’s been a year: a year since the first lockdowns and a year since the landscape of healthcare in the U.S. changed forever. While we’re still evaluating the impacts of the pandemic on healthcare policy, we now have seen enough data to assess the effect of the past year on alternative payments models and how participants are reacting.

It’s been reassuring to see the strength of APMs has broadly held steady, as has the resolve of the participants in those programs, despite the impact of the COVID-19 pandemic. Here’s what we’ve learned this year, along with what (we think) those lessons can teach us about the future.

1. COVID-19 has not stopped the progress of APMs — but it is delaying it. COVID-19 has extended the period of some programs, like the Comprehensive Care for Joint Replacement and Oncology Care Model, and delayed the start of others, like Kidney Care First and the Radiation Oncology Model. This is, in part, a function of an overwhelmed system. As policymakers and healthcare organizations respond to the pandemic, additional program flexibility has been necessary. This has given providers the chance to evaluate the sustainability of their participation in programs they’re already in, and, while dealing with constrained resources and personnel, deciding if the time is right to enter into new programs.
2. Most participants are sticking with APMs, despite the pandemic. While the policies stemming from the public health emergency introduced uncertainty into value-based programs, for the most part the pandemic has not scared many participants away. Rather, it is helping them learn what their tolerance for risk is in light of a major situation beyond their control. If anything, APM participants may have been better prepared for the challenge as a result of the value-based transformation they’ve already undertaken. Many participants have approached that transformation seriously and have spent the last couple of years thinking creatively about the ways they can improve care delivery. They have invested a lot of time, energy and money into transformation. Various programs had telehealth waivers in place before the pandemic, so when office visits and care shifted to a virtual format last year, those participants already had some experience to handle the shift. In instances where we saw tremendous declines in participation going into 2021, like in Bundled Payments for Care Improvement Advanced, there were other extenuating changes introduced to the program by CMS that tipped the scales unfavorably toward too much financial risk.
3. Forecasting risk moving forward could be a challenge. Forecasting performance may not have been easy before 2020, but it was easier to rely on trends from past years to make predictions on cost, improvement and risk. That’s going to be very different moving forward — and not just because 2020 data will be skewed. Moving forward, many patients who deferred care in 2020 for various reasons will re-engage with the healthcare market. Mental and behavioral health challenges are likely to become more important for managing patients’ overall health. That all points toward a high likelihood that the post-COVID era won’t just be picking up where 2019 left off, but will be the start of new trends and require new baselines.

What’s become clear is that while there are many changes, there will, at some point, be a return to the status quo. But that may be a while and it won’t be the status quo of the past. APM participants and any organizations interested in taking on risk or participating in value-based programs in the future should take as many lessons as they can from this past year to become even stronger in the years to come.

Reach out to DataGen to learn more about how to position yourself for success in the new healthcare landscape.