Health Tech

Aneesh Chopra: VBC Will Bring ‘Radical’ Transparency to Healthcare for These 3 Reasons

Aneesh Chopra, president and co-founder of CareJourney, predicted accelerated enrollment in value-based care models in 2024 and 2025. He thinks this will greatly increase healthcare transparency for a few reasons, including making data more available and influencing more primary care doctors to act as health information fiduciaries on behalf of their patients.

By Katie Adams on March 28, 2023

The healthcare system has seen “modest growth” in the last couple years in terms of the race to achieve 100% Medicare enrollment and the vast majority of Medicaid enrollment in value-based care models, Aneesh Chopra said Tuesday during a discussion we had at ViVE, a healthcare innovation conference in Nashville. He predicted that we’ll start to see major escalation in 2024 and 2025.

Chopra is one of the loudest voices in the industry clamoring for greater enrollment in value-based care models. He became the federal government’s first chief technology officer in 2009 and served under the Obama administration, and now he works as president and co-founder of CareJourney, a health analytics firm designed to facilitate participation in value-based care contracts.

One of the reasons Chopra is such a big proponent of value-based care is due to the transparency these care models bring to healthcare.

“It’s incredible the amount of transparency that we see. CMS has released all model data at the beneficiary and physician level for approved researchers going through the last 8 or so years, which allows us to see the growth and the trajectory. So we’re not having an academic debate about the progress, we’re actually using evidence,” he said.

In Chopra’s view, value-based care increases healthcare transparency for three main reasons.

  1. More available data: Fee-for-service healthcare is “struck by the issues of minimum data necessary and apples, oranges, bananas and grapes definitions of what a service is,” Chopra declared. Because data is not shared freely and service definitions are often inaccurate, price transparency and contract transparency are difficult to achieve in the fee-for-service world. The incentives are simply not aligned, he said. But in a value-based care world, there is an alignment of interests. Payer data “is always available” to providers, which gives them a full view of the patient’s journey, Chopra explained.
  2. Regulatory impact: CMS’ price transparency rule includes a provision that requires every employer in the country to disclose whether they’re in a value based care contract, Chopra pointed out. “Compliance with that provision may be modest, but it’s on the books, and it will get better with time. We’ve got radical transparency from CMS as to who’s in a value-based care relationship. It’ll be on the commercial side, and it’s inevitable that Medicare Advantage and Medicaid managed care plans will have to disclose this level of radical transparency at the 10 NPI level,” he said. Chopra predicted a snowball effect once it becomes widely visible which organizations are involved in value-based care contracts. “If I’m in a commercial fee-for-service relationship with a doctor who’s otherwise in a risk-bearing relationship with all these other plans, wouldn’t I want to incorporate my contracts to be part of the package? I don’t want to be the square peg in the round hole,” he explained.
  3. The role of the fiduciary: More and more primary care doctors are acting as health information fiduciaries on behalf of the patients for which they care, Chopra said. “In a way, price transparency isn’t about direct-to-consumer shopping. It’s about direct-to-consumer designated fiduciary shopping, and your risk-bearing primary care doctor can now incorporate price at the point of care — or more importantly, at the point of referral,” he declared.

Photo: IvelinRadkov, Getty Images