for the privilege. It was sponsored by 30 corporations, all of which participate in the VBP industry. Over 150 speakers, including five former administrators of the Centers for Medicare and Medicaid Services as well as representatives of corporations sponsoring the event, promoted value-based payment as the solution to the crisis in primary care. The conference vividly illustrated why the VBP industry poses a serious threat to doctors and patients.
Although the VBP diagnosis and solution has been promoted since the early 2000s , it took a decade for the VBP industry to take root deeply into our health care system. The Affordable Care Act , enacted in 2010, ignited its growth. The ACA conferred legitimacy on VBP by requiring CMS to insert VBP schemes into traditional Medicare .
CMS has implemented a half-dozen ACO programs since 2012, all of which focus on primary care doctors. Today, roughly 600 ACOs, many of them owned by insurance companies and other investors, enroll more than 11 million Medicare beneficiaries. Another 400 ACOs have been set up in the.
The speakers at the “summit,” studiously avoided discussion of VBP’s underwhelming effect on the cost and quality of health care, and rarely mentioned its worst side effects. If the experiment with ACOs and other VBP schemes authorized by the ACA had worked as advertised — if it had lowered costs and improved quality — advocates could at least argue that the harm done to medical care, especially to primary care physicians, was offset by improved “value.” But the research over the last decade clearly shows VBP schemes are