The US health care system is often criticized for putting profits before patients, exorbitant fees and overly complex processes that make it difficult to keep people healthy. Value-based care was supposed to improve this situation, experts say, but distorted incentives on the part of some health care providers are making it difficult to change the way health care is delivered.
When it comes to value-based care, most organizations don’t go beyond the bare minimum, health experts explain on LuckBrainstorm Health Conference in Dana Point, California, Tuesday.
While in the traditional system, health care providers are reimbursed for each service they provide, value-based care focuses more on reducing unnecessary costs and improving the quality of patient care, which typically requires more involvement from providers. Value-based care was developed as an alternative to the fee-for-service system, which some experts say fails to provide quality care to all patients.
While true values-based care requires dedication, the commitment of most organizations is “only an inch deep and a mile wide,” said Dr. Sachin Jain, CEO, SCAN Group & Health Plan.
Some programs simply do the bare minimum to check a box next to the Centers for Medicare and Medicaid Services and don’t actually change the way health care is delivered, added Dr. Rajai Batniji, CEO of Waymark, which provides community-based care for people on Medicaid.
“It’s unfortunate that so many value-based services operate almost like a loyalty program rather than something that can really change what people pay for in healthcare,” he said.
However, Batniji added that, for its part, Waymark has made progress in reducing unnecessary costs, one of the core principles of value-based care, through machine learning. January study in Nature Scientific reportsfound that Waymark Signal’s machine learning program was 90% accurate in predicting avoidable emergency department and hospital visits for Medicaid patients, outperforming existing Medicaid risk models.
Other changes still need to be made to improve patient outcomes, Jain said. One possible solution to improve health outcomes would be to move from one-year enrollment in Medicare health plans to a mandatory three- or five-year enrollment period. Because one year is not enough time to do more than an annual doctor’s visit, some value-based healthcare providers have little incentive to invest enough in a patient to see a return later. By moving to longer enrollment periods, value-focused healthcare providers have a better chance of making an impact.
“I think people will want to join him because it’s 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 one year.” , – He said.
Sign up for Well Adapted, our newsletter full of simple strategies to work smarter and live better, from the Fortune Well team. Register free today.