Of all the new advances in healthcare — artificial intelligence, predictive analytics, digitization of real-world evidence, and so on — one of the most disruptive is the shift toward value-based care.
A system that promotes value-based care represents a fundamental change in how the healthcare business functions: Rather than being reimbursed based on services performed, providers are paid based on specific outcome metrics (much like how the vast majority of businesses operate). This shift centers around improving the quality of care and ensuring positive patient outcomes.
However, the implementation of value-based care is proving to be tricky for providers. Doctors now report a slowdown in the shift to this model, citing insufficient information about their patients as a primary barrier to putting a value-based system into place. Essentially, they’re saying that providers can’t adopt value-based care practices because they don’t know what patients see as valuable.
This makes sense. For a patient entering remission from cancer, value usually means doing whatever it takes to prevent that cancer from coming back — even if it requires more visits to the doctor’s office. And for the approximately 3.6 million Americans who can’t visit the doctor because they don’t have reliable transportation, the value could be as simple as having an office located near a bus route.
To truly implement value-based care, then, the healthcare industry has to determine what “value” truly means to patients (and that certainly varies from individual to individual). This doesn’t just require new billing and reimbursement processes — it requires an entire transformation.
Combined approaches
We shouldn’t forget about the new surge of technology that’s improving the overall patient experience (and shifting healthcare as we know it).
Just consider mySugr, the ever-popular diabetes-management application. It syncs with patients’ glucose meters and allows them to easily log and track their day, which makes managing their condition much more seamless.
With these tech-based healthcare solutions, the role of doctors in improving the patient experience has changed. Digital tools can capture entirely new streams of data, but it’s up to doctors to single out any insights these tools miss.
In the same vein, as the technology doctors use improves, they’ll have to keep pace by supplementing that new technology with personal insight. In the context of value-based care, that means forming personal, trusting relationships with patients to identify where they can actually provide the most value.
Oftentimes, having a doctor with whom a patient feels comfortable and connected can be valuable in and of itself. Consider the research showing that black men — a demographic with the lowest life expectancy in the United States — are more likely to agree to preventive care when the advice comes from a black doctor.
Providers surely shouldn’t be reimbursed based on the race of their physicians, but these findings speak to a more holistic view of valuable care — one providers must adopt to significantly improve outcomes. Sometimes, that might mean making investments and taking actions that don’t show up on the balance sheet directly.
Challenges to consider in value-based care
Most barriers to implementing value-based care stem from the fact that each stakeholder — patients, doctors, administrators, insurers, and regulators alike — has a slightly different perspective on other stakeholders’ definitions of value. According to a survey by the University of Utah, physicians are more than twice as likely as patients to think the healthcare system as a whole bears responsibility for treatment costs. On the other hand, patients think the responsibility lies with insurance companies and themselves.
These perspectives won’t align overnight, but getting each party on the same page is a crucial step in setting a clearly defined standard for “value” in value-based care. The key is to do this incrementally, almost as if you were implementing a new AI tool. Start small, quantify the impact, prove its value, and then expand its scope. This is similar to agile business processes that now accelerate many new ideas and innovations.
One possible first step for providers might be to pursue more collaboration with patient advocacy groups. These are often specialized groups that understand a specific patient segment better than any single individual could, and working with them to determine what’s valuable and what kind of care can drive better outcomes could give doctors a starting point.
Whether the future of healthcare involves the current iteration of a value-based care system or something completely different, the idea of care based on outcomes isn’t likely to fade into the background. After all, it’s a driving force in the healthcare industry. Let’s not forget who should realize that value — and ensure they have a voice in the process.
