A recent survey of 1,000 consumers showed that only 26 percent had ever heard of the term “value-based care,” and of those, few knew what it meant. Moreover, 62 percent had never heard of the concept at all.
All of this underscores the first VBC-related challenge facing those within the healthcare industry — raising awareness. Communications must be improved on this score, and leaders in the sector must endeavor to bring greater clarity to the discussion of this model, because the industry is trending toward it.
Value-based care — i.e., reimbursement based on the quality of the care that is provided, as opposed to the sheer volume of services rendered (defined as fee-for-service) — is expected to be the model used by all Medicare beneficiaries and most Medicaid beneficiaries by 2030, according to the Centers for Medicare and Medicaid Services (CMS).
The CMS outlined those goals for its Innovation Center (known as CMMI) in an October 2021 whitepaper, and made known that its strategy for VBC implementation would center on accountable care, health equity, innovation and system transformation.
CMS administrator Chiquita Brooks-LaSure, the first African-American woman to head that organization, is acutely aware of the need for health equity. According to the website Revcycle Intelligence, she said that her aim is to “make sure that our programs are operating through these health disparities that underlie our healthcare system, which were especially illuminated by the COVID-19 pandemic.”
She added that the Biden Administration has made clear that “a whole-of-government approach” will be used to address racial equity and pledged that health equity “will always be the first question” asked by the CMS — that the organization is going to do everything it can to “break down barriers to care and lift up underserved communities.”
It is important to note that VBC is not solely about cost reductions, though that is obviously an important element. Rather, as noted in a 2019 paper by three researchers from the University of Texas’ Dell Medical School, the focal point of this model is on improved outcomes. The crux of the authors’ argument could be summarized in a single line from the paper: “If the real goal of value-based health care were cost reduction, painkillers and compassion would be sufficient.”
They point out that VBC should center on patients’ capability (the ability to do everyday things), comfort (relief not only from pain but anxiety) and calm (whether they can function normally while undergoing care), and summarize the underpinnings of this model as being an understanding of patient need, and the ability to formulate solutions and measure outcomes. And yes, they concluded, cost reduction will almost certainly come along with that.
Most physicians are still wedded to FFS models, but a Deloitte study revealed that half of them expect “a great deal of change” within the next decade, a conclusion that dovetails with the CMS’s goals. The word used throughout the Deloitte report is that clinicians must be “reoriented.”
That clearly holds true for consumers as well. They must be educated about value-based care, and given current trends, that education cannot begin soon enough. Because ultimately, they stand to benefit immeasurably from this pivot.