Creating a Value-Based Care Model
We can do better in healthcare. We need to pursue a model that amplifies the caring, compassionate nature of our caregivers rather than squelch it. Value creation is that framework.
Consensus exists among experts that the US healthcare system is dysfunctional. We spend more money per capita on healthcare than any other nation, yet our outcomes are among the worst compared to our peers.
A large part of this is due to our volume-based, fee-for-service healthcare model, paid by a third party that is not the actual consumer of the services and that only incentivizes price and volume. Communication is spotty at best, and huge gaps occur in collaborative efforts often leaving patients to fend for themselves.
Neither the quality of the outcomes nor the experiences of the patients have been intentionally considered in healthcare design or provision for decades, which makes the patients, providers, and staff feel like widgets, commodities, and cogs in this healthcare delivery machine we have operated since the early 20th century. To salvage US healthcare — and then help it thrive — we need to start creating value.
Value is relational, whereas volume is transactional. Value is longitudinal versus the episodic nature of volume. Value retains and grows its membership while volume tries to increase billable encounters.
Volume is based simply on price multiplied by unit. The Value Equation, though, looks like this:
Value can be created through the applied concepts of Population Health Management — risk stratification (cost), plan of care (quality), and longitudinal support (experience).
Individual and cohort risks need to be identified, including assessing Social Risks in a manner akin to checking physical vital signs. Patients can then be stratified based on those risks.
We must create appropriate, individualized plans of care and they must be grounded in best-practice medicine. An interdisciplinary team needs to develop an applicable approach that involves the patient and include mitigation steps for non-medical issues obstructing a patient’s journey toward health and well-being. In order to execute the plan, we need to do it in a communicative and collaborative manner, supporting and guiding the patient through an appropriate application of relationship and technology.
In this upcoming series of blog posts, I’ll address each of the pillars of Population Health Management and Value-based Care — risk stratification, plan of care and longitudinal support.
