Bass, Berry & Sims attorney Jennifer Michael was interviewed for the American Health Law Association (AHLA) podcast where she discussed value-based care, specifically as it relates to the various value-based enterprise (VBE) rules, and developments with VBEs since originally being announced in January 2021.
When asked about trends related to value-based care, Jennifer said she is “seeing clients focus on care gaps and opportunities for care improvements. So for example looking at gaps, those could be geographical gaps such as underserved rural communities or socioeconomic gaps such as dual eligible beneficiaries who aren’t accessing the right type of care at the right time. As far as care improvements, I’m seeing a focus frequently on disease states. So, for example, an entity that is really good at driving patient engagement in the diabetes space; or in the physical therapy space; as well as a focus on a stage of care, whether that be post discharge from a hospital … making sure patients are adhering to their discharge plan of care or making sure patients are considering all of their options and accessing palliative care when appropriate. So really it’s looking for those types of arrangements where the potential ROI of improving care is really compelling.”
In terms of opportunities in the value-based care space, Jennifer added that she thinks the industry will “continue to see more delegation of risk in the managed care space. Oftentimes entities can rely on the managed care safe harbors, but those don’t always work for every arrangement. And the value-based safe harbors allow more flexibility as far as patient engagement. The other big opportunity I’m seeing is the growing relevance of AI, especially for things like pattern recognition. Much like how the government uses data analytics to identify outliers for purposes of enforcement, entities can use those same data analytics to identify outliers for purposes of either identifying a target patient population or identifying individuals within that target patient population who perhaps need tools or supports.”
In conclusion, Jennifer offered the following insight, “the value-based safe harbors to the Anti-Kickback Statute are narrow. And so there is some continued tension between innovation and the fraud and abuse laws, which are designed to protect federal healthcare programs and beneficiaries. I’m still seeing so much room for AI. Think about having these as another tool in your arsenal, and as you think about AI, think about how it can be integrated into a value-based arrangement. At the same time, I’m seeing more and more bills and more FAQs every day. In January, Georgia proposed a bill to restrict the use of AI in healthcare, and just earlier this month, CMS issued a FAQ about the use of AI with respect to MA organizations. So keep your finger on the pulse.”
The full episode, “Hot Topics in Value-Based Care and the Value-Based Enterprise Rules,” was released March 19 by the AHLA Speaking of Health Law Podcast and is available online.