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Is Value-Based Care Making an Impact?

Handling Problems With Self-Pay Patients

While most consumers are aware of the various ways that the Affordable Care Act (ACA) affected the insurance industry, few know about some of the other major provisions of the bill, like value-based care.

“So, what does that mean?” you might ask.

Well, consider the following information: according to one source, between $40 million and $50 million for every $1 billion of net healthcare revenue is spent on unnecessary tests and treatments.

“Person for person, healthcare in the U.S. costs about twice as much as it does in the rest of the developed world,” stated a recent Consumer Reports article. “In fact, if our $3 trillion health care sector were its own country, it would be the world’s fifth-largest economy.”

According to the Kaiser Family Foundation, “Health spending per person in the U.S. was $9,451 in 2015 –  22% higher than Luxembourg, the next highest per capita spender.” The conclusion drawn was that the U.S. spends a “disproportionate amount” on healthcare each year relative to the country’s overall wealth.

Based on this data, the easy conclusion is that the U.S. has a major problem with healthcare-related costs, which was the core inspiration for the concept of value-based care. Within this type of system, legislators sought to not only increase or maximize the quality of care, but also to regulate costs in an effort to lower overall per capita healthcare expenditure in this country.

Considering that value-based care has been a major priority for practices and hospitals for several years now, the question at this point—especially with all the coverage and pending legislation related to healthcare—is has it worked?

The answer, unfortunately, is much more complex than a simple yes or no.

Successes

  • Practices and hospitals have moved away from pay-per-service models and started to develop different payment models that focus more on overall health outcomes than on simply providing the service—more of a “treat the disease and not the symptoms” kind of approach.
  • Providers are more effectively tracking clinical outcomes in order to address challenges that may be affecting the quality of care provided across the industry.
  • The patient experience and patient satisfaction have become central to provider goals, an aspect of the industry that was sorely lacking prior to value-based care.

Setbacks

  • Tracking outcomes is not a simple matter. As Jason Goldwater, MPA, MA, and Senior Director of the National Quality Forum stated in another article, “There is a fatal flaw with how we do patient-reported outcomes at the moment and that is you have to rely on an instrument to be able to provide that information.” According to Goldwater, physicians are creating the assessments to track patient satisfaction and health outcomes based on what they think is important to the patient, which is not always accurate.
  • The technology component inherent in value-based care still needs greater development. According to a recent study by Quest Diagnostics and Inovalon, 70 percent of physicians stated that they did not see how electronic health record (EHR) systems are contributing to “better patient outcomes.” Frustration with these systems has been an ongoing issue for a while now, and it’s something that needs to be corrected in order for the industry to develop and become more efficient, as was intended by implementing the technology in the first place.
  • The savings on a national scale are not as significant as they need to be. According to Holly Martin, a senior manager at Top Tier Consulting who was recently quoted in a HealthcareDive article, the Centers for Medicare and Medicaid Services (CMS) has seen some reduction in payments, but not enough. “CMS is pleased with the trend and the progress,” she said, “but the actual dollar amounts that are being saved are not huge compared to the healthcare spend overall.”

While it’s obvious that value-based care has not achieved all of the intended results, that’s almost to be expected, considering the short time frame in which it has existed. Realistically, the concept has only been in place for less than a decade, and it’s been a process of constant development, growth, and re-evaluation.

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On the plus side, some real progress has been made towards changing the way we think about healthcare in the U.S., but we still have a long way to go.

Luckily, according to the Quest Diagnostics and Inovalon study cited above, it appears value-based care should be here to stay. Their study found that roughly 82 percent of physicians and health executives believe that the healthcare changes in Washington will have little effect on the existence of value-based care in the industry.

If that is the case, the concept will have time to grow, take root, and truly have the impact that it should on healthcare spending in the U.S. and the expectations patients have for the nature and quality of their healthcare.

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