As a seasoned reporter in North Florida, I’ve seen how our U.S. health system often falls short of meeting patients’ needs. With sky-high costs and complicated processes, it’s clear that the system, in many cases, prioritizes profits over patient health. Enter the concept of value-based care – a proposed remedy for these issues. However, experts argue that the transition to this model is being hindered by the self-interest of some medical providers.
Understanding Value-Based Care
When discussing value-based care, it’s critical to understand that many organizations are doing the bare minimum. This insight was shared by health experts at the recent Fortune’s Brainstorm Health conference in Dana Point, California. Unlike the traditional system where health providers are paid per service, value-based care attempts to reduce unnecessary costs and enhance patient experiences. This usually requires more involvement from the providers.
This care model was developed as an alternative to the fee-for-service system, a model that experts argue fails to deliver quality care to all patients.
However, the commitment to true value-based care requires dedication. According to Dr. Sachin Jain, the CEO of SCAN Group & Health Plan, most organizations’ commitment is “only an inch deep and a mile wide.”
Checking the Box or Real Change?
Unfortunately, it appears that some programs are merely doing the minimum required to satisfy the Centers for Medicare & Medicaid Services, rather than genuinely altering their care delivery approach. This point was underscored by Dr. Rajaie Batniji, the CEO of Waymark, a company that offers community-based care for Medicaid patients.
“Unfortunately, so much value-based care operates almost like a loyalty rewards program, rather than a true change in healthcare payment,” he lamented.
Despite these challenges, Batniji shared that Waymark has made progress in reducing unnecessary costs, a key principle of value-based care, via machine learning. A recent study published in Nature’s Scientific Reports found that Waymark’s machine learning program, Waymark Signal, accurately predicted 90% of avoidable emergency room and hospital visits for Medicaid patients.
Improving Patient Outcomes
Further changes are needed to enhance patient outcomes, asserted Dr. Jain. One potential solution could be extending the enrollment period in Medicare health care plans from one year to three or five years. This would give value-based care providers more time to invest in patients and potentially see a return.
“I think people will want to enroll into it because it’ll be intuitive that a health plan that owns your life for three or five years is going to view your care very differently than a plan that owns it for a single year,” he stated.
As the discussion on value-based care continues, it’s clear that more needs to be done to truly put patients first. But with continuous advancements and conversations in the field, there’s hope for a future where health care is both affordable and effective for all.
