New VA Center for Innovation for Care and Payment to Test Novel Payment and Service Delivery Models
Congress recently passed the VA Maintaining Systems and Strengthening Integrated Outside Networks (MISSION) Act to consolidate programs that provide Veterans access to non-VA care, and formally establish a coordinated, high-performing network of VA and private sector providers. The MISSION Act also establishes a VA Center for Innovation for Care and Payment to be staffed by VA employees and contractors with expertise in demonstrations and evaluations. Through this Center, VA will have the ability to test novel payment and service delivery models. The new Center also empowers VA to collaborate with other payers to drive improvements in quality, costs, or efficiency. The new VA Center has goals similar to those of the Centers for Medicare and Medicaid Innovation (CMMI) Center created by the Affordable Care Act. Both Centers are empowered to engage private providers in value-oriented experiments with innovative payment models, but VA's Center is also charged with innovating within VA's national network of public hospitals and clinics. There are several advantages to studying innovative care and payment models inside the nation's largest integrated delivery system, such as:
- VA's large and diverse patient population allows researchers to evaluate how new delivery models impact specific patient populations;
- VA's comprehensive electronic health record (EHR) allows investigators to utilize data not otherwise accessible through other public or private systems; and
- Healthcare networks that include both VA and private sector providers give VA the ability to make use of heterogeneity in geographic practice patterns in comparing effectiveness of treatments and management strategies.
Additionally, VA's Center for Innovation for Care and Payment will have the opportunity to choose from a wide array of urgent topics, including suicide prevention and the opioid crisis. Veterans are deeply affected by both issues. Among the Center's priorities could be sponsorship of an evaluation of targeting and outreach intensity for Veterans at high risk for suicide, coupled with a rigorous accounting of costs and outcomes to support evidence-based policy. To assist in decelerating the opioid crisis, the Center could help develop and test value-based payment methods with stronger incentives for community-based, medication-assisted treatment (MAT), which is supported by strong evidence but is under-provided.
If some challenges can be overcome (i.e., upgrading data infrastructure and analytic capabilities), the new VA Center for Innovation could play a pivotal role in health system transformation. It could do so not only for Veterans, but for millions of Americans who face the same health concerns and suffer the same consequences from the shortcomings of our current healthcare financing and delivery systems.
Drs. Pizer and Frakt (Director) are part of HSR&D/QUERI's Partnered Evidence-based Policy Resource Center (PEPReC) in Boston, MA. Dr. Clancy is VA's Deputy Under Secretary for Discovery, Education, and Affiliated Networks, Washington, DC.
Pizer S, Frakt A, Sheetz K, and Clancy C. Testing Novel Payment and Delivery Approaches through the Veterans Health Administration’s New Center for Innovation. Annals of Internal Medicine. Commentary. December 25, 2018;epub ahead of print.