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AcademyHealth 2018 National Health Policy Conference
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Dr Gail Wilensky Examines the Shift to Value-Based Care

Gail Wilensky PhD, senior fellow at Project HOPE, addresses the shift to value-based care over the years and what can be done to keep moving forward.

Gail Wilensky PhD, senior fellow at Project HOPE, addresses the shift to value-based care over the years and what can be done to keep moving forward.


Have you seen progress in the shift to value-based care in the recent years? What efforts do you think are needed to accelerate this shift?

I’ve been very disappointed at how hard and how slow it’s been to shift to value-based care. I think several things are going on. We have too many metrics being used; I think we need to drastically consolidate the number of metrics. It would be helpful to have a smaller set used by various payers not each individual payer coming up with their own and a smaller set at that. It’s clearly harder than we thought it would be to be able to move the needle on this.

I also think it would require that much more the reimbursement be put at risk. You can’t expect, particularly, clinicians to respond to an incentive that has quite small effect on their overall reimbursement, either because it’s a very small percent of the overall reimbursement or they, as a particular type of clinician, don’t have very many of those patients. The institutions, the hospitals seem to respond with relatively small changes, although if you really want to get their attention, you ought to increase that, as well. So, we need to keep at it.

The notion of paying as though quality didn’t differ dramatically and efficiency and price didn’t differ dramatically across different institutions is just wrong. We just haven’t figured out how to get it right yet.

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