Ask the Legal Expert about ... the ACA repeal's effect on value-based contracting

John Durso, Esq.  Nixon Peabody LLP
John Durso, Esq. Nixon Peabody LLP

Will President Trump's “repeal and replace” Obamacare campaign pledge impact or modify value-based contracting?

The Affordable Care Act, which President Trump campaigned to “repeal and replace,” will continue to have an impact on the marketplace.

The “replacement” aspect of this campaign pledge is still unclear and being developed and may impact providers and value-based contracting.  Nevertheless, the ACA had three goals that all payors will still seek to implement even after any “repeal” of the ACA.  

The primary goals of ACA were: High-quality of care with strong consumer approval; wellness care models that focus on preventing illness in populations; and lower costs to Medicare or any payor. These goals have caused accountable care organizations to structure themselves to act through “value-based contracting” with their providers, which include hospitals, physicians and organizations providing services to seniors.  These primary goals of the ACA will continue to motivate payors and providers even after any changes to the ACA, regardless of any “replacement” strategy.  

Thus, value-based contracts should remain important in the marketplaces.  Organizations that provide services to seniors should continue to strive toward these ACA goals by focusing on wellness programs that provide quality care yet at lower costs.  

The fact is senior care service organizations must be able to demonstrate to all payors through data and clinical protocols that they further these value-based goals and are aware of other issues affecting providers, (e.g., reducing readmissions of patients back to a hospital).  Payors will continue to provide patients to all providers of care that can improve quality and lower costs.