HEALTH CARE'S NEXT PHASE.

• Author: Wilcox, David
• Position: MEDICINE & HEALTH

"Value-based care has the potential to shift us from a siloed or isolated provider-based payment model to one that is patient focused."

WE ARE A NATION of consumers and when we buy something, we judge the quality of the goods we are purchasing, or at least we should. No one wants to buy a car that they continually have to take back to the dealership for service. So, why shouldn't health care operate in the same fashion? After all, you cannot take back a nasty scar after a botched appendectomy operation. You need to do your work on the front end.

As health care costs continue to climb, it is time to realize that fee-for-service is not going to be a sustainable model. There has to be an essential shift in health care, and that essential shift is quality outcomes. A quality outcome is the measure of the impact of a health care service, such as how many patients contract or receive an infection while in the hospital or die due to complications from surgery. The U.S. health care system is managed by various regulatory bodies that often cite organizations for inadequate care and often decrease or stop reimbursement payments for health care organizations lacking in positive quality outcomes. Value-based care incentivizes health care organizations to provide quality care at a decreased cost.

This is important to understand because this is how care is going to be delivered in the future.

Value-based care focuses on all aspects of care coordination. In the fee-for-service model, medical care frequently is provided in silos, meaning your doctor is not speaking to other members of your health care team. Communication with the entire team would enable everyone to see your complete health care picture together. Value-based care incentivizes the health care team to communicate to keep you out of the hospital. If done correctly, this will reduce the costs, improve the quality of your care, and provide greater incentives to the health care team when it can meet the goal.

Let's explore the business model for a minute. In the fee-for-service model, the doctors or health care organizations do not get paid unless you present with a symptomatic illness. They make their money treating sickness in a reactive manner. The medical staff gets paid according to the volume of patients they see, not necessarily on how well the patients do. In value-based care, they are incentivized to keep you healthy and out of the hospital. That means if the health care organization or doctor's office is collecting $1,000 a month per head for each patient from the insurance company payor, the health care organization or doctor's office gets to keep the profit if they can keep you out of the hospital.

When you show up at the hospital with an illness, you are costing your provider part of his or her incentive. Instead of bringing in revenue to the health care organization or doctor's office as in a fee-for-service model, you are costing the health care organization or doctor's office revenue...