Changing to a value-based healthcare system


Adam Albright

In America today, healthcare has remained one of our biggest successes as well as one of our biggest problems. The United States has some of the smartest providers, best institutions, best medical technology, and most innovative thinkers. Yet, the average cost per person is much higher than those of other developed nations, and our people as a whole are experiencing less favorable outcomes. This poses a question: “Why?”

To educate those of you who aren’t familiar with the current system, I’ll explain it as I know it can be incredibly challenging to understand due to the sheer amount of moving parts in it.

The reimbursement model in the United States has revolved around a fee-for-service practice for decades. Fee-for-service is a model that compensates physicians on each service rendered rather than the outcomes of the services they provide. What’s the problem with this? Well, say there is a patient who is going in to be seen for some shoulder, elbow or wrist pain. The doctor under the fee-for-service model will have you do an X-ray, maybe throw in a CT scan because why not, and then proceed to tell you that you need surgery, and will be requiring anesthesia because it will be a very invasive procedure. The doctor then gets reimbursed for every single step of that procedure from X-ray to surgery which is incredibly expensive. But that process cost is not the end.

After the patient incurs all of those costs, and the physician then gets reimbursed for the services provided, the patient is discharged home and that attending physician is completed with the process. Hopefully, some of you can anticipate what problems may occur as I am writing this. The patient goes home with minimal follow up instructions, and maybe a simple referral to another physician who can take them under their wing during the rehabilitation process. The new doctor isn’t extremely aware of the patient’s past conditions and notices that very invasive surgery wasn’t necessarily needed and may cause more problems down the road. The new doctor recommends a new course of care, and the cycle continues until the patient either faces detrimental health outcomes or significant financial stress. 

What’s the solution? A single-payer system? No. It’s simply (or not so simply) changing the way our current model operates and changing the way we reimburse our physicians. Yet this can be tricky as physicians are always motivated by financial incentives, as they should be due to the rigor and importance of the work they do.

How can we create a model that improves outcomes and reduces overall costs? It’s called Value-Based Healthcare. 

Value-Based Healthcare is a model that compensates physicians not on the services rendered but by the outcomes and quality of the work they do. Sounds simple and ethical right? Well, it is. The only problem is we have been trapped in this financially addictive model that treats patients like objects, not offering the very best care possible, the care we are capable of offering. 

Lately, great progress has been made with this model and physicians are starting to latch onto the idea. I was fortunate to work for an organization in the summer that exercised this model, and the results were outstanding. It’s amazing how many people, whether it be physicians or analysts behind the scenes expressed enthusiasm about this model because the work was truly “good” work, not just superficial treatment. The main improvement of this model is that once a patient is discharged from a clinic, emergency department, or another form of a treatment center, they are not written off like a ballot. They are followed thoroughly, tracked on their progress, and offered services that will truly help them down the road. 

This will improve costs and quality of direct care, and the latent effects will be very noticeable with time. For example, Minnesota is facing one of the worst opioid epidemics of our time. With a model like a Value-Based Care system, physicians are no longer paid for handing out narcotics like candy. Rather, they are tracked and compared to their other physicians all with the main goal of reducing the use of painkillers by offering better follow up care, mitigating the chronic use of those painkillers. Latent effects like that will be able to conquer many of today’s societal problems, and we haven’t even begun to witness all of the possibilities due to the small scale adoption Value-Based Care has had thus far. But, it is growing.

Like-minded physicians are coming on board, and at the end of the day, the truly great physicians will crave accountability, because they inherently hold themselves to the highest of standards. No longer will the success of a physician have a negative correlation with a patient’s health outcomes; rather, both providers and patients will achieve success together, and people in the United States will get the very best care possible, healthcare they deserve.