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What Are the Constructs of Value-Based Care?


Moderator Scott Gottlieb, MD, asked panel members about the current trend toward value-based models in terms of healthcare reimbursement, and how they would define value-based care and what they believe is the ultimate goal in changing to this model.

Kavita Patel, MD, MS, indicated that “value-based care” is still not well-defined. What the administration is trying to do is change the infrastructure of the payment model. Rather than continuing with a volume-based payment model, the current administration wants to manage health with an interdisciplinary approach under a global payment structure. And while national legislation has helped with this shift in models, as with the Medicare Access and Chip Reauthorization Act, the transition will be difficult.

John L. Fox, MD, MHA, agreed that changing over payment models would be a challenge, especially within a 3-year time span. Hospital and system administrators have seen that the only way to get more healthcare dollars is by going “at-risk.” Profit margins are as high as ever, Dr Fox said, and there’s less momentum to become an accountable care organization (ACO).

“The other irony of this is… that right now the arrangements are for gainsharing only and the behavioral economist will tell you that you work a lot harder when you have something to lose than when you have something to gain,” Dr Fox stated. The big question, then, is will people be willing to change their models and take risks once it’s mandated, especially when the imperative to take those risks has been taken away?

Ted Okon agreed with Drs Fox and Patel, adding that gainsharing is like competing against oneself and, thus, not a viable option. Larger health systems, for example, are already pulling out.

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