Episode Overview:

It’s no secret that healthcare is changing rapidly – and policy can play a big role in that change. With a new administration comes new rules, so healthcare providers must dig in to understand the implications across the board. In this episode of Value-Based Care Insights, Mollie Gelburd, JD, Associate Director of Government Affairs at MGMA, joins Daniel J. Marino and Shaillee Juneja to discuss anticipated policy changes in healthcare.


Daniel J. Marino
Daniel J. Marino, Managing Partner, Lumina Health Partners

Shaillee Juneja
Shaillee Juneja, Principal, Lumina Health Partners


Mollie Gelburd
Mollie Gelburd, JD, Associate Director of Government Affairs, MGMA

Episode Discussion Areas:

1. What is the "public option"?

    1. A new perspective — how it compares to old models.
    2. Allows the participation of value-based care.

2. Pulse of Washington on value-based care.

    1. Biden expanded coverage under ACA.
    2. Shift of site of service with ASCs.

3. Trump administration.

    1. Encouraged fewer models and more financial incentives — wanted to save costs.
    2. VBC is creating a paradigm shift in leadership.

4. What can leaders do to be more prepared for the unknown that comes with policy changes?

    1. Review ACO changes — current and new changes with Democratic undertones to decisions.
    2. 2021 fee schedule updates— evaluate to understand immediate impact.
    3. Revenue — understand what will affect reimbursement moving forward.

5. What three big policy shifts will impact medical group management under the Biden administration?

  1. Episode 30 Quote

7 Key Takeaways: 3 Policy Shifts That Will Impact Value-Based Care

  1. Department of Health and Human Services has been directed to expand ACA.
    1. Coverage expansion will ensure patients maintain their health. A public option, like Medicare expansion, could let patients buy in and get coverage.
  2. What is the future of ACOs?
    1. They’ll continue to focus on value-based care, but it’s unclear if that focus will be on participation and not just cost savings. Providers need flexibility to make changes to existing models to increase efficiency.
  3. Hospitals have been focusing on revenue recovery and management.
    1. COVID has highlighted the limitations of fee for service.
    2. Strategic partnerships support cost savings and track quality; meet quality and cost thresholds; and help providers achieve goals.
  4. Value-based payment models under ACOs and APMs can be a lifeline when volume is down.
    1. Some models offered stable cash flow through upfront payments and shared savings payments. During COVID, value-based payments have offered stability.
  5. Telehealth adoption is a positive that came from COVID.
    1. It’s changed delivery and access models, and utilization has soared — especially for vulnerable populations.
    2. Medicare requirements for telehealth and billing restrictions have relaxed and may continue in that direction.
  6. Digital health initiatives will advance care.
    1. Virtual care and remote patient monitoring can benefit patients, but a keen focus isn’t there yet. With for-profit companies investing in digital health, this will eventually be addressed and incorporated in patient care.
  7. There’s a continued opportunity for education.
    1. This administration is likely to pivot access to care, reimbursement of care, and the financial planning and sustainability of healthcare organizations. Organizations, consumers, and providers must stay current on policy changes and understand their impact.

Resources mentioned:

2021 Healthcare Provider Initiatives to Improve Financial Performance

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasing value-based care payment environment. Hosted by Daniel J. Marino and Shaillee Juneja, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners.

Daniel J. Marino

Podcast episode by Daniel J. Marino

Daniel specializes in shaping strategic initiatives for health care organizations and senior health care leaders in key areas that include population health management, clinical integration, physician alignment, and health information technology.