What Is Value Based Care, And Why Is The Healthcare Industry Suddenly So Interested In It?

Value based care (VBC) has become an increasingly popular buzzword, ensnaring much of the attention and press with regards to “the future of healthcare.” Many startups, large healthcare payor 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 the quality and “value” of care delivered to the patient, rather than the amount of care delivered. An article in the New England Journal of Medicine defines it as “a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.” This creates a baseline incentive shift in the industry: rather than compensation being linked to quantity of care, VBC incentivizes the clinical outcome.

This is in contrast to a strict fee-for-service (FFS) approach that many organizations and healthcare systems currently engage, in which providers are paid per procedure or per the actual services rendered.

Unsurprisingly, there are proponents 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 to drive up profits. Critics of VBC, on the other hand, indicate that the systemic infrastructure is not in place to do justice to value based care. For example, if a patient goes in to see a physician regarding wrist pain, in a VBC model at its truest sense, the physician would also be tasked with counseling this patient on topics related to lifestyle changes, such as smoking cessation and weight loss. While this is certainly a valuable aspect of care, that same physician likely has 40 other patients in his/her waiting list for the day, creating significant time constraints for such value-driven counseling.

Companies, healthcare organizations, and governments recognize the limitations of the different care delivery models, but have recently been eager to transition to VBC, as healthcare pricing is rapidly becoming chaotic. Many startup companies are attempting to tackle the VBC space aggressively. Take for example CareBridge, which received nearly $140 million dollars in funding this past year. The company “assists health plans and states in caring for individuals receiving home and community-based services,” and its “solutions include 24/7 clinical support, decision support, data aggregation, and electronic visit verification.”

Some other startups are attempting to tackle VBC initiatives in specific care domains. Somatus, for example, works with health plans, health systems, and provider groups to provide “integrated care to patients with or at risk of developing chronic kidney disease or end-stage kidney disease.” Leveraging key partnerships and advanced data tools, the company aims to create a comprehensive ecosystem for patients that require kidney related care.

Even some traditional payor organizations have now embraced VBC as the next revolution in healthcare. Aetna, which is one of the world’s largest payors, explains: “At the center of VBC models is a robust, team-oriented approach, often led by the patient’s primary care doctor. Patients aren’t left to navigate the health care system on their own. The care team is there to support them along their health care journey. Teams are expected to focus on prevention, wellness, strategies and coordination throughout the care continuum, priorities especially important for those managing chronic conditions. The 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 total health.”

Indeed, the goal of pursuing VBC is to create a proactive, holistic approach to care delivery, and ultimately treat the person, rather than just the symptoms.

However, as alluded to above, there is still a significant amount of work left to be done with regards to 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 leaders, and executives can convince the masses that VBC is even worth pursuing, especially as FFS pundits continue to emphasize its demerits, accordingly.

Nevertheless, the transition from one system to another will not occur overnight, nor will it be smooth. Rather, what will likely occur, 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.