The Intersection of Medicare Value Based Care and Obamacare Preventive Care Mandates

Ben H.

Hatched by Ben H.

Sep 04, 2023

3 min read


The Intersection of Medicare Value Based Care and Obamacare Preventive Care Mandates


In the ever-evolving landscape of healthcare, two key areas of focus have emerged in recent years: Medicare Value Based Care (VBC) and the preventive care mandates under the Affordable Care Act, often referred to as "Obamacare." While these may appear to be distinct topics, a closer examination reveals a potential intersection that could have significant implications for the future of healthcare in the United States.

Medicare Value Based Care 101:

Medicare, the largest VBC system in the nation, has been implementing the Medicare Shared Savings Program (MSSP) since 2012. With over 10.7 million beneficiaries covered in 2021, this program has reported savings of $2.0 billion dollars. The MSSP offers various contract options, including "One-Sided" contracts that share in savings only and "Two-Sided" contracts that share in both savings and losses. Additionally, there are different methods for assigning beneficiaries to the ACO risk pools, such as "Prospective" or "Retrospective" assignment.

The Impact of the Preventive Care Mandates:

Under the Affordable Care Act, health insurance plans are required to include coverage for a range of preventive care services, including HIV-preventing drugs, cancer screenings, and other essential preventive measures. However, a recent court battle has cast doubt on the constitutionality of these mandates. U.S. District Judge Reed O'Connor ruled that certain preventive care requirements under Obamacare are unconstitutional, sparking a legal debate that has reached the federal appeals court.

The Possibility of a Temporary Compromise:

In an intriguing twist, attorneys involved in the legal battle have hinted at the potential for a temporary compromise that would maintain the coverage of preventive care services while the court case unfolds. This compromise, if reached, could provide a reprieve for the mandates and ensure that individuals continue to have access to crucial preventive care measures, including HIV-preventing drugs and cancer screenings. Such a compromise would bridge the gap between the Medicare VBC system and Obamacare, highlighting the interconnected nature of healthcare policies.

Finding Common Ground: The Value of Preventive Care in VBC:

While the focus of Medicare VBC is primarily on cost savings and improving patient outcomes, preventive care plays a crucial role in achieving these objectives. By providing access to preventive services, individuals can avoid costly treatments and interventions down the line. Preventive care measures, such as cancer screenings and early disease detection, can lead to earlier interventions and ultimately better health outcomes for Medicare beneficiaries. Recognizing the value of preventive care within the VBC framework could help bridging the gap between the two initiatives.

Actionable Advice for a Synergistic Approach:

  • 1. Foster Collaboration: Encourage collaboration between Medicare VBC programs and health insurance plans to ensure that preventive care services are integrated into value-based care models. This collaboration can include shared data, coordinated care management, and aligning incentives to prioritize preventive care.
  • 2. Education and Awareness: Promote education and awareness campaigns to inform Medicare beneficiaries about the importance of preventive care and the services covered under Obamacare mandates. By empowering individuals with knowledge, they can make informed decisions about their health and seek appropriate preventive care measures.
  • 3. Policy Alignment: Advocate for policy alignment between Medicare VBC and Obamacare preventive care mandates at the legislative level. This includes addressing any constitutional concerns raised by the legal battle and working towards a unified approach that prioritizes cost savings, improved outcomes, and access to preventive care for all individuals.


As the nation grapples with the intersection of Medicare Value Based Care and Obamacare preventive care mandates, it becomes clear that a synergistic approach is not only possible but also necessary for the future of healthcare. By recognizing the value of preventive care within the VBC framework and finding common ground between the two initiatives, we can create a healthcare system that prioritizes both cost savings and improved patient outcomes. Through collaboration, education, and policy alignment, we can bridge the gap and ensure that individuals have access to the preventive care services they need while fostering a sustainable and efficient healthcare system for all.

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