Medtronic and Aetna will partner on a program to measure health outcomes for type 1 and type 2 diabetes patients who take multiple daily insulin injections.
The patients will move to pump therapy using a Medtronic insulin pump.
Hooman Hakami, president of the Diabetes Group at Medtronic, said the project “reinforces our shift toward value-based healthcare.”
The outcomes-based, risk-sharing agreement will tie Medtronic’s reimbursement to “successfully meeting agreed-upon clinical improvement thresholds for Aetna members with type 1 and type 2 diabetes who choose to transition from multiple daily injections to a Medtronic insulin pump, with the goal of elevating patient experience, improving clinical outcomes and lowering the total cost of care.”
This move to a value-based payment system means Medtronic needs to go beyond just offering the technology. The company must also work with diabetes patients to improve outcomes and patient experience and lower care costs.
Linking outcomes and costs is becoming increasingly common. Recently, UnitedHealthcare and Aledade announced a new accountable care organization program to improve healthcare in Arkansas. Also, Kaiser Permanente co-signed a letter with other healthcare leaders, including Medtronic, in April that called for a value-based healthcare system that puts the patient at the center of care and focuses on outcomes. The CMS also sees potential in value-based care and has already converted 30% of its fee-for-service payment to a value-based model with a goal of 50% by 2018.
Not everyone is convinced that a value-based program will consistently improve outcomes and patient experience and lower costs. A report earlier this month in The New England Journal of Medicine found that Hospital Value-Based Purchasing programs did not improve measures in clinical process or patient experience and was not associated with “significant reductions” in two of three mortality measures.
Holly Martin, senior manager at Top Tier Consulting, recently told Healthcare Dive, “Part of the challenge is people are changing and innovating and seeing results in quality and cost, and Medicare is seeing some reduced payments, but the accumulated learning experience is hard to consolidate nationally… CMS is pleased with the trend and the progress, but the actual dollar amounts that are being saved are not huge compared to the healthcare spend overall."