Value-based care not only advances quality and equity in healthcare, it accelerates innovation in care delivery. VBC rewards preventive care and effective management of chronic conditions by tying hospital and clinician reimbursement to patient outcomes. The result has been a rise in team-based care models, data-driven medicine and provider connectivity.
While health systems have slowly adopted VBC, their leaders remain enthusiastic about its possibilities. An analysis by The Health Management Academy found that a majority of chief strategy officers named “expanded payer partnerships” and “expand footprint in risk-based arrangements” among their 2023 priorities.
However, concern also lingers that value-based care might stifle the innovation it intended to drive. That’s because in determining quality for payment purposes, most VBC programs reward the use of evidence-based solutions with proven track records. Favoring this existing standard of care could block promising solutions that don’t presently have a mountain of evidence behind them.
A great example of this is the teleneurohospitalist service available across many health systems. With neurologists in short supply, few community hospitals have access to timely and reliable neurology coverage. Under this innovative care model, a panel of teleneurologists fills this gap, consulting with hospitalists and responding immediately to emergencies. In one case, the panel detected status epilepticus, a potentially life-threatening form of seizure activity, in an ICU patient who appeared to be sleeping. With appropriate and timely treatment, the patient avoided tragedy and was awake and alert the next day.
Hospitalists and hospital administrators heap praise on the teleneurohospitalist program and the value it provides. However, under VBC, it remains a paradox. As a new program and one of the first of its kind, there are no published papers linking it to patient outcomes. On the other hand, access to on-demand neurology care helps hospitals improve quality metrics like length of stay, patient-reported outcomes and readmission rates. In other words, they help hospitals succeed under VBC and alternative payment models.
For all its reliance on data and evidence, the reality is that transitioning to VBC won’t be a seamless process. New technological advancements are coming at us fast and furiously. The research and regulations guiding their use and reimbursement can’t keep up with this rapid pace. At the same time, traditional categories are blurring. Payers are offering services, morphing into “payviders.” And a teleneurohospitalist program encompasses providers, technologies and delivery systems. Put it all together, and historic concepts of “reimbursement” and “standard of care” begin to crack.
So, what should be our North Star through this transition? In a word, our patients. Yes, it’s true that the lure of cost-containment and financial rewards may initially draw many organizations into risk-based arrangements. However, the beauty of VBC is its patient-centric heart. It finally and definitively links financial success to improved health and quality of life.
As healthcare leaders, we must develop and implement the latest care advancement models that our patients expect and deserve. As advocates of both patient experience and quality care, it’s our duty to always put patients’ best interests first, especially as care innovations develop and grow.
How do we deliver on this promise? Most will begin by seizing the low-hanging fruit. Healthcare organizations can invest in their data infrastructures and work with one another to achieve interoperability. Professional organizations can update their standards of care more frequently to reflect the rapid pace of healthcare innovation. Health tech startups can design better decision support tools when they factor in important considerations such as clinical efficacy and expected benefits.
But fundamentally, healthcare leaders may need to embrace promising treatments, therapies, technologies and business models when they are approved, especially if they deliver improved clinical outcomes and an improved patient experience.
In other words, as leaders, we must go first. VBC will eventually catch up, but only if we build an innovative future to draw it forward.
Theo Koury is president, Vituity, Emeryville, Calif., and an ACHE member.