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Advancing Value-Based Cardiovascular Care

May 2020 199 © 2020 American Heart Association, Inc. 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 cardiovascular 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.