Value-based care (VBC) has become an increasingly popular buzzword, garnering much attention and press regarding the “future of healthcare.” Many startups, large healthcare payer organizations, provider groups, hospital systems, and even technology companies want to invest in VBC.
But what exactly is value-based care?
The term VBC specifically refers to a care delivery model that emphasizes qUALITY and “worth” of the care given to the patient, instead of amounts of care provided. A ITEM The New England Journal of Medicine defines it as “a health care delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care arrangements, providers are rewarded for helping patients to improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. This creates an initial incentive shift in the industry: instead of compensation being linked to amount of care, VBC stimulates clinical outcome.
This is in contrast to a strict fee-for-service (FFS) approach that many health care organizations and systems currently employ, in which providers are paid per procedure or for the actual services provided.
Surprisingly, there are supporters and critics of both methods. Critics of FFS discuss how the model incentivizes providers to order more tests and engage in more procedures, even if they are unnecessary, as a means of increasing profits. Critics of VBC, on the other hand, point out that the systemic infrastructure is not in place to do justice to value-based care. For example, if a patient goes to see a doctor about wrist pain, in a VBC model in its truest sense, the doctor would also be tasked with counseling this patient on topics related to lifestyle changes. lifestyle, such as smoking cessation and weight loss. While this is clearly a valuable aspect of care, the same physician likely has 40 other patients on his or her waiting list for the day, creating significant time constraints for such value-driven counseling.
Companies, healthcare organizations and governments recognize the limitations of different care delivery models, but have recently been eager to move to VBC as healthcare prices are rapidly becoming chaotic. Many startup companies are trying to tackle the VBC space aggressively. Take CareBridge for example, which received approx 140 million dollars in last year’s funding. The company “helps health plans and states care for individuals receiving services at home and in the community,” and its “solutions include 24/7 clinical support, decision support, data collection and electronic visit verification.”
Several other startups are trying to tackle VBC initiatives in specific areas of care. Somatus, for example, works with health plans, health systems and provider groups to provide “integrated care for patients with or at risk of developing chronic kidney disease or end-stage kidney disease.” By leveraging key partnerships and advanced data tools, the company aims to create a comprehensive ecosystem for patients seeking kidney-related care.
Even some traditional payer organizations have now embraced VBC as the next revolution in healthcare. Aetna, which is one of the largest payers in the world, explains: “At the heart of VBC models is a robust, team-oriented approach, often led by the patient’s primary care physician. Patients are not left to navigate the healthcare system on their own. The care team is there to support them throughout their healthcare journey. Teams are expected to focus on prevention, wellness, strategies and coordination across the continuum of care, priorities especially important for those managing chronic disease. Multidisciplinary care team may include case managers, mental health specialists, social workers, pharmacists, dieticians, educators, psychologists, health coaches, administrators, and others. While not all team members provide direct medical care, they work together with the patient and caregivers to help identify and address each individual’s health care needs. The idea is to engage patients, help them solve problems and better manage their overall health.”
Indeed, the goal of pursuing VBC is to create a proactive, holistic approach to care delivery and ultimately treat the person, not just the symptoms.
However, as alluded to above, there is still considerable work to be done regarding the infrastructure to support VBC. This model requires significant resources, including administrators, specialists and primary care experts, in addition to significant buy-in from allied health professionals. Furthermore, this will only be effective if regulators, policy makers and executives can convince the masses that VBC is worth pursuing, especially as FFS experts continue to highlight its shortcomings, accordingly.
However, the transition from one system to another will not happen overnight, nor will it be smooth. Rather, what is likely to happen is the creation of hybrid models that will attempt to emulate the best of both systems in order to ultimately best serve patients and communities at large.