Alternative payment models (APMs) are a way for insurers to pay providers to encourage better health outcomes. Accountable Care Organizations (ACOs) are physician-group practices that opt into an agreement with Medicare or another insurer to be paid a specific amount per patient, rather than being paid for individual health care services. In ACOs, the physician group practice makes money when the patient stays healthy and will lose money if the patient does not stay healthy.
The Value in Health Care Act of 2023 will expand the current APMs and ACOs models by making specific changes to make it easier for physician groups to participate and increase payment. It increases the payment originally authorized under the Medicare Access and CHIP Reauthorization Act (MACRA) by 5 percent for two years. These funds would provide doctors' offices with enough funding to establish and improve these types of programs.
This value-based care could be an important tool for kidney doctors. Physician offices would be incentivized to keep patients with chronic kidney disease from progressing to end-stage renal disease (ESRD) because the practice makes more money when the patients stay healthy. The tools physician groups could use are screening for CKD, kidney disease education to ensure the person with CKD understands nutrition and exercise, and the use of prescription drugs like SGLT2 inhibitors to stop the progression of kidney disease.
Even though the United States Preventive Services Task Force (USPSTF) has not yet recommended yearly screenings for CKD, an APM could provide physician offices with an incentive to find kidney patients early and implement interventions to stop the progression of this disease.
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