Guest Column | July 26, 2018

Value-Based Care Done Right Can Move The Needle Towards Better Healthcare

By Stephen Dart, AdvancedMD

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Value-based care (VBC) has become a key component in our efforts to improve healthcare and reduce costs. Yet, various stakeholders regard VBC differently: If I asked 10 people to define VBC for me, I’m sure I’d get 10 different responses. The absence of agreed-upon VBC goals by all contributes to the “what’s in it for me” or “what will it cost my organization” mindset where the focus is on who’s going to pay for care and who’s going to get paid and how much.

Stakeholders Define VBC Only From Their Point Of View
Most stakeholders view VBC only from their individual frame of reference. When payers talk about VBC, they are primarily concerned with reducing redundancy in services and ensuring that patients receive only the care they need, thus lowering costs. This reduction approach can make providers feel that they are forced to omit part of the care their patients need. Providers are being asked to trust that other work was done, and done correctly, outside of their purview.

Now look at VBC in the context of the patient. Besides shouldering a larger part of healthcare costs, they are being asked to weigh in on medical decisions. Should they allow their doctor to use last month’s lab test results because insurance won’t pay for another round, although the doctor has requested fresh tests? Should patients be put in a position to negotiate what care they need? How do they determine “value” in that context?

As an EHR vendor responsible for technology meeting regulatory certifications, I have to view VBC through the lens of data collection to enable providers to capture and report on what care they delivered. But from a patient frame of reference, these requirements are meaningless. What value do you, as a patient, see from reports ensuring the doctor has followed some specific protocol? Patients assume any care-related protocol is already followed and has been for decades.

It’s Time To Shake Up The Status Quo

Most everyone can agree that if patients receive better care and become healthier, the overarching cost of healthcare in the United States will be reduced dramatically. However, that goal remains elusive as long as the industry is fragmented into groups of stakeholders who each have their variable in this broad equation. Each group wants their variable to become a constant so they don’t have to sacrifice anything. From a mathematical point of view, there must be different values for the variables to solve an equation; they can’t all be constants. Vendors want to stop chasing regulations and put their R&D budget into innovation, providers want to give the best care possible, payers want to stop overpaying, and patients want to stay or get healthy without huge cost. It’s time to remind all healthcare stakeholders that achieving success in any team game requires sacrifices for the broader team goal. 

Some changes have begun to take place. Payers are beginning to pay for prevention programs. Many companies are developing wellness programs and technology to help people stay or get healthy, and employers are footing the bill. Even retail has gotten into the game. These efforts all enable individuals and companies to reduce their insurance costs. However, there are still many millions of individuals who have no real incentive to change to a healthier lifestyle, to become educated as to why it matters to them, to look at how they live or how they get care.

We also don’t think enough about how we reimburse providers. If the answers always boil down to cost reduction, then the equation becomes simple. Reduce everything, which is not likely to achieve anything. Reimbursing physicians for chronic care management looks good on paper, but the burden of proving they are meeting the objectives is so high that most don’t bother. It’s not because the concept is bad. The execution is flawed.

Unifying Goals Will Lead To Fundamental Change

Government regulation plays a role in healthcare, but it should not be focused so much on cost reduction but on policy, big ideas that reward companies that innovate and can show how their innovation has impacted patient populations. Today VBC is micromanaging around metrics that aren’t even agreed upon within the governing bodies. Patient population management and VBC will remain lofty concepts until we have unified goals around what we’re trying to accomplish with them. Overarching policies must be defined, followed by incentives for all stakeholders to get behind those policies. Otherwise, we’ll continue to operate in a phase of “perpetual planning.” The time it takes to agree and execute a plan equals the obsolescence of the solution, which means the planning needs to start over again.

When the incentives start matching goals, we’ll have progress in healthcare. When everyone gets on the same page, everyone will win because we’ll be paying and reimbursing on “value,” with value being interpreted as value to every stakeholder.

About The Author

Stephen Dart is Sr. Director of Product Management at AdvancedMD, a cloud software provider for independent medical practices based in South Jordan, Utah.