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Defining value: What does this term really mean?

Medical Economics JournalDecember 25, 2019 edition
Volume 96
Issue 24

You don’t need to dig too deeply to uncover the drawbacks of mandated value-based care, and why real value may be found in a much simpler way.

How should doctors define value?

At first blush, the shift from volume to value appears progressive, thoughtful and even prescriptive for a healthcare system burdened with treating too many patients in too little time at too high a cost. But appearances can be deceiving, and you don’t need to dig too deeply to uncover the drawbacks of mandated value-based care, and why real value may be found in a much simpler way.

The original intent was sound, aimed at fulfilling the quadruple aim of healthcare and rewarding physicians with incentive payments for quality of care versus quantity of services.

However, the nature of many value-based care models appears to be more about value to the insurer, the employer and the hospital. The physician and patient, who rightfully should be at the forefront, may be at the very end of this line.

The term “value” itself has different meanings to all involved in healthcare, naturally viewed through each individual lens. Patients value compassionate care that decreases suffering and pain and is available at their convenience with minimal out-of-pocket expenses, while payers define value as overall population health at the lowest cost possible. Agreeing on a common value proposition for healthcare becomes almost impossible to achieve, given the diverse goals-quality, service, cost, outcomes, access-of its main stakeholders.

Even the question of who bears primary responsibility for a patient’s health improving is one without consensus as shown in the recent Value in Health Care Survey: physicians overwhelmingly assigned themselves responsibility, patients assigned responsibility equally to themselves and physicians, while employers split accountability among patients, physicians, health system, insurers, and themselves. Value, it seems, is in the eye of the beholder.

So it’s not surprising that the push toward value-based care has met with mixed results. A recent study from the Healthcare Financial Management Association showed value-based payment models had no impact on cost or clinical outcome reduction in their early years.

Half of physicians surveyed for a 2018 Future of Healthcare report felt that value-based care and reimbursement will have a negative impact on overall patient care, and 61% said it will also negatively affect their practice, with concerns expressed about decreasing reimbursement rates and resources needed for additional documentation and data collection.

Concierge medicine offers an exceptionally viable solution, simultaneously simplifying and transforming the physician’s practice. Independent physicians remain that way, unfettered by the need for tedious documentation to prove value and achieve financial sustainability. This type of personalized care drives down the need for urgent care and ED visits, and improving outcomes for patients. 

Most importantly, physicians are able to fulfill their personal vision for patient care. As one of our clients eloquently sums up: “All those things that we’re not compensated for in traditional primary care medicine are the most essential things.” That’s the real meaning of value-based care.

Terry Bauer is CEO of Specialdocs, a concierge practice transition and management company established in 2002.

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