Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why health care fails to deliver better value in patient care

Kristan Langdon, DNP and Timothy Lee, MPH
Policy
February 8, 2021
Share
Tweet
Share

There is a strong push for health care to move towards greater value-based care (VBC) arrangements. The prospect of VBC holds the opportunity to re-create partnerships designed to increase health care sustainability by strategically improving processes, care delivery, and patient outcomes to achieve higher quality output at a decreased cost. Furthermore, the held potential will not be optimized until providers, payers, patients, and communities are connected in this common goal and as equal stakeholders in health system redesign.

Providers, payers, and patients all stand to benefit from greater development and alignment of VBC arrangements. Patients want more connected and transparent care that is convenient to their needs and avoids unnecessary delays in services. Providers want to receive on-time accurate payments and reduce administrative burdens so they can spend more time connecting with the patient and focusing on health outcomes. Payers desire higher value (primarily assessed through performance on standardized quality metrics) with minimalized utilization waste while building patient and provider loyalty and trust.

Likewise, communities serve as the cohesion between patients, providers, and payers. Engaged communities fuel VBC models and preserve investment on behalf of providers and payers. Investing in and through the community leverages resources local to the patient and supports infrastructure efforts in improved quality of care.

A suboptimal system

VBC models need incentive transparency and mutually beneficial terms for all parties to meet value-based goals. Many payers lack health outcome data on members from provider EHR databases. Providers lack the billing and claims data on patients to which they provide care. Without full predictive data-mapping, providers and payers individually are unable to assess current and future risk planning decisions, and thus VBC contracts are being made via a marginalized roadmap.

Shared knowledge of comprehensive patient/member data currently only exists when payer and provider are in an exclusive relationship for care provision such as in a managed care model. However, it is feasible to create this same incentive in shared information through VBC contracts when established in the right terms.

Redesigning value-based care contracts

In efforts to promote VBC, we propose a new framework called the Value Compass to rethink the way value-based care contracts are designed and incentivized. The Value Compass concept focuses on meeting societal health care needs through four key stakeholders (payer, provider, patient, and community) and balancing between these groups to align value-based models. Imbalance in any stakeholder contribution causes the Compass to shift and makes value-based outcomes more difficult, if not impossible to achieve.

From the Value Compass Framework, specific value-based models are then designed to focus on data interoperability, clinical evidence protocols, collaboration, and other capabilities to enable value-based care contracts.

Incentives to form partnerships

Payers and providers have traditionally had different incentives and unequal balance in VBC agreements. This has led to complacency with continuation of traditional fee for service contracts and a slower adoption in VBC. In 2018 only an estimated 25 percent of all health payer contracts had a value-based component. To date, this estimation has not greatly shifted despite climbing health care costs and less than ideal outcomes in health care quality compared to cost.  One potential explanation is VBC negotiations’ portrayal as hostile and having the wrong expectations from the outset; often setting the union on unstable ground in developing a partnership of any enduring value. Thus, in redesigning the system, VBC needs to be a win-win partnership that incentives both parties from both a financial and non-financial aspect.

From a financial perspective, payers can encourage providers to take on more risk by providing better reimbursement rates and cost-savings revenue for high-performing providers. However, non-financial incentives should be leveraged to enhance hospitals and provider groups struggling to maintain single-digit operating margins. For example, payers can support providers and enable easier adoption of value-based care by adding new capabilities like detecting burnout or creating analytical tools. Thus, non-financial incentives can also dissipate previously hostile relationships and open dialogue around collaborative strategies to get to value-based care sooner.

Applying the Value Compass Framework to a value-based contract

A partnership between a community hospital system and a local payer in North Carolina is a prime example of the application of the Value Compass framework when establishing a value-based contract. A shared model with financial and non-financial goals allowed the community hospital system and payer to establish a progressive relationship invested in collaboration and assessment of mutual return on investment overtime.

ADVERTISEMENT

Data sharing as terms of the arrangement addressed the problem of having incomplete data and provided both stakeholders the ability to utilize data insights, determine key performance metrics, and measures of quality monitoring. Since a comprehensive picture of the patient’s health journey was now obtainable, the provider was encouraged to take on more downside risk.

Data operability further informed standardization of quality metrics and specified benchmarks for improvement for the payer-provider population. The findings enabled sharper focus to align the payer-provider partnership with patient and community stakeholder needs, completing the balance of the Value Compass.

Moving value-based care forward

To redesign health care and promote VBC, it is recognized no single entity or organization by itself can redefine and extract value that benefits all a population. Instead, alignment amongst stakeholders who are not only willing to establish and participate in non-financial and financial engagements, but view all other stakeholders on an equal playing field is necessary to effectively address issues such as data interoperability, clinical evidence protocols, and sustainability of value-based contracts.  Engagement at the level of the four key stakeholders is critical and has the potential to move VBC from a place of stagnant rumination to a beneficial process towards health care redesign.

Kristan Langdon is a nurse practitioner. Timothy Lee is a health care strategist.

Image credit: Shutterstock.com

Prev

Stop the us vs. them mentality in medicine

February 8, 2021 Kevin 5
…
Next

How physicians can engage on social media

February 8, 2021 Kevin 1
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Stop the us vs. them mentality in medicine
Next Post >
How physicians can engage on social media

ADVERTISEMENT

More by Kristan Langdon, DNP and Timothy Lee, MPH

  • Unlocking the power of value-based care: How collaborative partnerships drive health care success

    Kristan Langdon, DNP and Timothy Lee, MPH

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why health care replaced physician care

    Michael Weiss, MD
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • The triad of health care: patient, nurse, physician

    Michele Luckenbaugh

More in Policy

  • Why nearly 800 U.S. hospitals are at risk of shutting down

    Harry Severance, MD
  • Innovation is moving too fast for health care workers to catch up

    Tiffiny Black, DM, MPA, MBA
  • How pediatricians can address the health problems raised in the MAHA child health report

    Joseph Barrocas, MD
  • How reforming insurance, drug prices, and prevention can cut health care costs

    Patrick M. O'Shaughnessy, DO, MBA
  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Most Popular

  • Past Week

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Aging in place: Why home care must replace nursing homes

      Gene Uzawa Dorio, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • The silent burnout epidemic among parents and doctors

      Wendy Schofer, MD | Physician
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Why the Sean Combs trial is a wake-up call for HIV prevention

      Catherine Diamond, MD | Conditions
    • Why real medicine is more than quick labels

      Arthur Lazarus, MD, MBA | Physician
    • New surge in misleading ads about diabetes on social media poses a serious health risk

      Laura Syron | Conditions
    • Stop medicalizing burnout and start healing the culture [PODCAST]

      The Podcast by KevinMD | Podcast
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
    • Stop blaming burnout: the real cause of unhappiness

      Sanj Katyal, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Aging in place: Why home care must replace nursing homes

      Gene Uzawa Dorio, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • The silent burnout epidemic among parents and doctors

      Wendy Schofer, MD | Physician
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Why the Sean Combs trial is a wake-up call for HIV prevention

      Catherine Diamond, MD | Conditions
    • Why real medicine is more than quick labels

      Arthur Lazarus, MD, MBA | Physician
    • New surge in misleading ads about diabetes on social media poses a serious health risk

      Laura Syron | Conditions
    • Stop medicalizing burnout and start healing the culture [PODCAST]

      The Podcast by KevinMD | Podcast
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
    • Stop blaming burnout: the real cause of unhappiness

      Sanj Katyal, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why health care fails to deliver better value in patient care
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...