Designing Value-Based Care Programs Around Arrhythmias

The conversation shifts toward how value-based payment models might apply to atrial fibrillation care, drawing comparisons to existing bundled payment programs for coronary artery disease and heart failure. While value-based arrangements have shown success in reducing unnecessary procedures—like catheterizations through coronary CT angiography—the complexity of atrial fibrillation care presents unique challenges. Important outcome measures for such models could include hospital admissions for arrhythmias, rates of repeat ablations, and stroke incidence, with incentives tied to quality and utilization metrics rather than fixed bundles, which may reinforce system inefficiencies rather than improve care.

Designing effective value-based care for atrial fibrillation is further complicated by overlapping comorbidities common in cardiometabolic diseases, such as hypertension, sleep apnea, and diabetes. Rather than isolating atrial fibrillation costs at the individual electrophysiologist level, incentive models are better suited for cardiology groups who can collaboratively manage best practices and comprehensive patient care. Quality measures should encompass not only anticoagulation management but also control of contributing risk factors, reflecting a holistic approach to AFib management.

Pharmacists are highlighted as essential members of the care team in this value-based framework. Their expertise in medication management, monitoring therapy safety, and handling the complex medication regimens common in cardiometabolic patients can help optimize treatment, reduce adverse events, and alleviate provider workload. Integrating clinical pharmacists into remote monitoring and chronic disease management programs can enhance patient outcomes and support the economic sustainability of these care models. This teamwork approach will be critical in developing future care pathways that are both patient-centered and value-driven.