During his six years at the CMS, Dr. Patrick Conway oversaw the agency’s big push into value-based reimbursement. He was deputy administrator for quality and innovation and headed the Center for Medicare and Medicaid Innovation. Late last year, Conway left the CMS Innovation Center to become CEO of Blue Cross and Blue Shield of North Carolina. While he’s now removed from rulemaking, Conway remains passionate about the idea of linking payment to outcomes. He recently spoke with Modern Healthcare Editor Emeritus Merrill Goozner. The following is an edited transcript.
MH: Let’s turn to another one of the major programs that you had at the Innovation Center ACOs and the Medicare Shared Savings Program. How do you see its future?
Conway: Overall, the Medicare ACO program improved quality and improved patient experience and had modest savings. On the savings, it’s important to note the ACOs that were in the program longer saved more money. Physician-led ACOs, on average, saved more money. And those ACOs at two-sided risk—at partially capitated or capitated-type payments like Next Generation ACO—did the best.
I think those programs will continue in Medicare, but they may be modified in some ways. In the private market, including in North Carolina, private payers are putting ACO contracts in place with independent physicians and large health systems. We have an ACO that just reported $20 million in savings, but more importantly, the patients in that system are getting coordinated care. They have nurses calling them to make sure they get the care they need.
MH: To what extent do you see the private sector becoming the driver of these? Do you think that the momentum is
there for them to keep going and expand it even without a push from government?
Conway: I do. In North Carolina, we’re going to work to move the majority of our payments to providers into a partnership model like ACOs and bundled payments where the provider is accountable for quality and total cost of care and quality goes up and costs go down.
MH: There are so many strands of reporting requirements quality indicators, process indicators, outcomes indicators. What can be done to lessen the regulatory burden on physician offices and on hospitals?
Conway: At one point in my career, I led quality reporting for a large health system, Cincinnati Children’s Hospital Medical Center, and we had over 700 measures we were reporting to various entities. You cannot improve on 700 things. As a general rule of thumb, you want to try to get 30 or fewer quality measures and 10 or fewer is even better, for providers to improve on.
Original article can be accessed here.