The conversation focuses on the challenges and frustrations surrounding value-based care, particularly in oncology, and the issues healthcare providers face when dealing with the financial pressures of Medicare Advantage (or “Medicare Disadvantage”) plans as some people refer to them. Dr. McAneny expresses concern about the recent changes in Medicare policies, including the Inflation Reduction Act’s elimination of drug margins, which will significantly impact oncology practices, particularly by underfunding crucial services like care coordination and patient support. She emphasizes the difficulty of balancing the best care for patients with the financial viability of a practice, noting that the current reimbursement system does not reflect the true costs of providing cancer care.

Dr. McAneny argues that value-based care should compensate providers for the comprehensive work they do in oncology, including research, care coordination, and the complex decision-making involved in treatment planning. She believes that providers should not be forced to choose between doing what is best for the patient and maintaining the financial health of their practice. Her concerns extend to the inequities faced by rural practices, where delivering care in underserved areas is more expensive yet reimbursed at lower rates. She suggests that Medicare’s payment system should be adjusted to account for these disparities and to ensure that practices in rural areas are not financially disadvantaged.

In closing, Dr. McAneny calls for a more nuanced approach to value-based care, one that includes input from physicians and is centered on improving the quality of care rather than focusing solely on cost savings for insurers. She advocates for the development of multiple, small-scale projects driven by doctors that can be scaled and tested for effectiveness. By allowing healthcare providers to innovate and find what works best in care delivery, she believes healthcare systems can become more efficient and equitable, benefiting both patients and providers alike.

Key Takeaways:

• Value-Based Care Needs to Address Physician Realities: Dr. McAneny emphasizes that value-based care models should fairly compensate physicians for their work, especially for the time spent coordinating care and creating treatment plans. Current models often fail to reflect the true costs of care, leading to financial challenges for practices.
• Support for Rural and Underserved Areas: She advocates for adjusting reimbursement rates to support practices in rural and underserved areas. Rural practices face higher operational costs, yet Medicare and other payers often pay less to care for patients in these regions. Flipping the geographic price cost indicators (GPCI) to provide more resources for rural care could help address health disparities.
• Risk-Based Programs Should Not Be Placed on Providers Alone: Dr. McAneny calls for a more balanced approach to risk in value-based care, stating that practices should not be left bearing the full risk without the resources or support to manage it. She argues that risk-based programs often favor payers over providers and harm the infrastructure needed to deliver effective care, particularly in specialty fields like oncology.

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