Value-Based Payment Reforms in Cardiovascular Care: Progress to Date and Next Steps

Abstract

In an effort to curb excessive health care spending and incentivize high-quality care, many payers have implemented value-based payment reforms designed to pay for the quality rather than the quantity of health care services. Medicare, the largest payer in the United States, has implemented numerous value-based payment policies over the past decade, many of which affect cardiovascular care. In this review, we discuss some of these major nationwide value-based payment reforms as they relate to cardiovascular care and what we may expect in the future from cardiovascular value-based policies.

Keywords: cardiovascular diseases; delivery of health care; health care reform; health expenditures; quality of health care.

Figure 1.

Trends in United States Health Expenditures in selected years between 1960 and 2017. National health expenditures in billions of dollars (green bars and left-sided axis) and as a percentage of United States gross domestic product (GDP) (blue lines and right-sided axis). Publically available data was obtained from the National Center for Health Statistics.

Figure 2.

Graphical representation of bundled payment versus traditional fee-for-service payment for an episode of care. (A) An example of an episode of care that begins with hospitalization for treatment of an acute myocardial infarction (AMI) with percutaneous coronary intervention (PCI) and includes related health care services through 90 days after discharge, including services such as home health care, outpatient rehab, and readmissions. (B) Traditional fee-for-service payment models reimburse hospitals and providers for each service delivered during the course of that 90-day episode of care. (C) In bundled payment models, hospitals are held accountable to a single benchmarked payment for the care delivered, regardless of the quantity of services provided.

Figure 3.

Participation in specific cardiovascular episodes as a percentage of all episodes that participants (ie, hospitals and physician groups) volunteered for in Model Year 3 of BPCI Advanced (N = 12,717). All episodes are initiated as inpatient clinical episodes except for outpatient PCI and outpatient defibrillator. Data were obtained from the publically available BPCI Advanced model year 3 participant file. BPCI: Bundled Payment for Care Improvement; AMI: acute myocardial infarction; PCI: percutaneous coronary intervention; CABG: coronary artery bypass graft; TAVR: transcatheter aortic valve replacement