Healthcare 360: Reimagining Healthcare Delivery

July 03, 2024

Podcast: Reimagining Healthcare Delivery

On this week's episode of Healthcare 360, Dr. Rob Fields sits down with Scott Strickland, attorney and shareholder with Hall Render, a healthcare focused law firm, to discuss his unique perspective on healthcare delivery and payment models.

Innovation in Healthcare Policy

In 2010, Scott Strickland joined the Department of Health and Human Service’s Office of General Counsel, Centers for Medicare & Medicaid Services (CMS) Division, Program Integrity Branch, where he worked on the development and implementation of the Medicare Shared Savings Program. Just a few months after the Affordable Care Act (ACA) passed, Strickland was at the very center of the excitement surrounding the enactment of the new law, as well as the challenges and opportunities it presented to the healthcare industry.

During his conversation with Dr. Fields, Strickland admits to sometimes feeling disconnected between the daily legal and policy work, and the tangible results that’s happening on the ground. However, with this work, that was not the case for Strickland.

“In this event, you could see that this was, in many respects, a life changing law for a number of people who were not covered and then all of a sudden had access to health care coverage, health insurance coverage,” says Strickland, “In that respect, I think there was a lot of pride coming through.”

As part of the team who worked to implement the Medicare Shared Savings Program, Strickland worked directly with a team of policymakers within CMS and the affiliated Innovation Center to develop alternate payment models for healthcare in accordance with fraud and abuse laws. The team developed and tested new healthcare service delivery models with the goals to improve patient care, lower costs and align systems to patient centered practices.

“The existing Stark Law and Anti-Kickback Statute are more geared towards traditional, fee-for-service models. We were moving towards models that have that fee-for-service overlay, but, we were transitioning to payments based on the quality of care provided, outcomes, care, savings, and the like,” says Strickland, “I was working with policymakers to come up with what would be appropriate waivers for the fraud and abuse laws in these programs and rules related to beneficiary incentives.”

Exploring Healthcare Delivery Models

As the healthcare system in the United States continues to evolve, the debate surrounding the future models of healthcare delivery remains a prominent discussion. The concept of value-based care remains in the conversation on the future of healthcare delivery, a framework that prioritizes the quality of care and patient outcomes. Dr. Fields asks Strickland his opinion on value-based care as the future model for healthcare in the U.S.

“I'm still a true believer in the necessity for a shift away from the fee-for-service model and towards a model that does a better job of rewarding and incentivizing quality of care and the actual outcomes from a patient perspective, rather than just the volume of care,” says Strickland.

Strickland goes on to highlight a key challenge in implementing a value-based care model, which is ensuring that specialists, along with primary care physicians and clinicians, are appropriately incentivized within this framework. He adds the necessity to transition to this model of care with deliberation to not put in jeopardy the many health systems across the country caring for patients.

“We’re still in the early stages, conceptually,” says Strickland, “We're mostly in a fee-per-service world still, and we're still dealing with organizations that have been built to succeed within that framework. We need to be careful that as we're moving to a world where more of that total revenue is tied to value-based-care payer arrangements that we're not moving so fast that we actually just jeopardize the financial viability of these systems that we're going to depend on and need in the new model.”

Every other week, we'll chat with a leading expert in healthcare to learn about the many challenges and opportunities facing the industry Listen to the full conversation with Strickland here, and check in regularly for new episodes of Healthcare 360.

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