Cardiovascular Perspective: Advancing Value-Based Cardiovascular Care

Despite tremendous progress and innovation in addressing cardiovascular disease (CVD) over the past half century, improving value in CVD care remains an urgent issue.¹ CVD is the leading cause of mortality and disability in the United States,² its clinical outcomes vary tremendously, and improvements in these outcomes are slowing.¹ Further, CVD costs are continuing to rise, and cardiovascular drug innovation is lagging.¹

These challenges are occurring at the same time as promising new care models and clear opportunities for biomedical innovation are emerging.¹ Yet these opportunities are not being broadly capitalized upon because the current payment system for cardiology, largely based on fee-for-service reimbursement, fails to provide incentives for care redesign. Fee-for-service reimbursement in cardiovascular care does not promote longitudinal management, focuses on illness rather than wellness, underutilizes nonphysician clinicians, encourages invasive and intensive treatments for later-stage disease instead of shared decision-making about treatment options or palliative care that improves quality of life, and separates primary care from cardiovascular specialty care.³ Consequently, CVD care remains fragmented, expensive, and uncoordinated, with lower quality than ideal.³

However, things are beginning to change: the current payment system has begun significantly shifting to value-based arrangements⁴ that support better cardiovascular care.^3,5 As of 2018, 36% of all dollars are flowing through alternative payment models, up from just 25% a few years earlier.⁴  These value-based models, especially ones further away from fee-for-service, can provide significantly more flexibility around provision or reimbursement of services crucial to good cardiovas-cular care, such as care coordination, team-based care, remote monitoring, behavioral tools, and social and community interventions.³

We briefly highlight progress, challenges, and opportunities for value-based cardiovascular care and important next steps taken by the Value in Healthcare Initiative¹—a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University.

The full text of this article is available at https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006610