Dr Farzad Mostashari: Short-Term Thinking Is One of Healthcare's Biggest Challenges

One of the greatest challenges for the healthcare industry as it moves to value-based payments is shifting from a short-term to a long-term mode of thinking, Farzad Mostashari, MD, chief executive officer of Aledade, explained at the National Association of ACOs Spring 2016 Conference.

Transcript (slightly modified)

What are the biggest challenges facing the healthcare industry in the move to value-based payments and how do we overcome them?

I think one of the biggest issues is actually around the long-term thinking that we need.

Fee-for-service, in essence, is the essence of short-term thinking. Fee-for-service is the essence of “coin operating” mentality. You want me to do something—feed the meter, right? Put a coin in, get a candy bar, right? Like, the training that we’ve done, our provider systems, our whole infrastructure is we expect very quick returns on whatever action that we’re paying for.

Value-based payment means you have to take a longer view of things, you have to invest in things. We’re investing a lot of time and attention on vaccinations. That’s not going to pay off in 3 months or 6 months, but it is over the long run. Quality does improve costs over the long run. We need to be able to have long-term thinking. And I think sometimes people who have been trained in short-term thinking and fee-for-service mentality have trouble seeing that if you prevent one emergency room visit that that actually, over the next 12 to 18 months, is going to have a return to you.

So there’s a lot of work that has to be done upfront, there’s a lot of capital needed, there’s a lot of investment needed upfront that will bear fruits months to years down the line and we have to have the belief and the resources to be able to stick in the game over the long run. And that’s one of the challenges that I see for a lot of ACOs and all the ACO providers is in impatience with “well, are we going to get savings in year one” and “where’s the check?” and “you want me to do what?” and “are you paying me for that?” And that, I think, is a challenge on the transformation side.