Tag: value based care

No More ‘Dabbling’: It’s Time to Embrace Value-Based Care

Feb 25, 2025

By ALEX AZAR

Presidential transitions are always a time of great change, but few leaders have ushered in a shift as sweeping as the rewiring of one-seventh of the U.S. economy. President Trump has the opportunity to do just that by doubling down on the health transformation achievements of his first term.

A key to success is continuing the shift from a fee-for-service (FFS) healthcare model to value-based care (VBC). The current FFS model continues to deliver higher costs and greater utilization of healthcare resources—but not better outcomes for patients. By contrast, a VBC model ties provider payments to quality patient care that incorporates prevention and coordination.

As a country, we’ve been dabbling with value-based models for decades. Now, the time has come to rip off the proverbial Band-Aid and embrace system-wide changes.

We actually have more evidence than most people realize in favor of alternative care delivery and payment models.

Significant positive changes have already occurred in the primary care space through programs like the Medicare Shared Savings Program (MSSP).

Where Are Health Care’s Value Meals?

Jul 2, 2024

By KIM BELLARD

If you’re anything like me, you’ve noticed that food costs have been increasing. Whether it is food from the grocery or at a restaurant, the bill can be eye-opening compared to a few years ago. Blame the pandemic, blame corporate greed, blame the President – take your pick. But the bottom line is, you have to eat. You can buy lower priced options, you can go out less often, you can skimp on non-food spending, but you’re going to buy food. The other thing you can do is to complain.

Well, the fast food industry, for one, is listening to those complaints, and many leading fast food companies have launched a variety of “value meals” to reduce the pain consumers feel. Evidently they are still capable of feeling shame, or at least of recognizing that consumers have choices.

I just wish the healthcare industry was capable of doing the same.

Let’s be clear: the fast food industry has brought this on themselves. The Wall Street Journal reports that prices of food eaten away from home rose 30% since 2019, according to labor Department statistics, and that prices for a Big Mac increased 21% over the same period. McNugget meals were up 28% over the same period.

McDonald’s recognized the problem. It announced a $5 meal bundle in mid-May, targeting a June 25 launch date. For those of you craving a McD’s fix, the deal includes McDouble or McChicken sandwich, small fries, small soft drink and a four-piece Chicken McNuggets. “I’ve been in our restaurants. I’ve sat in focus groups,” Erlinger said on the Today show, touting the new deals.

It didn’t take long for other fast food chains to offer their own version. KFC introduced its $4.99 value menu back in April, even before McDonald’s announcement. Wendy’s has a $3 breakfast deal, Burger King has a $5 Your Way Meal, Taco Bell has something it calls a Luxe Craving Box for $7, Starbucks has a new Pairing Menu priced between $5-$7, Jack in the Box has a $4 munchies Meal, and Sonic now offers a $1.99 menu it calls “Fun.99,” which it says will be permanent, not a time limited promotion. I’m sure there are others.

“It still holds true that imitation is the sincerest form of flattery,” Burger King North American president Tom Curtis said in a May email to restaurant operators. “We know the competition is doing that. So we will be in that game,” Jack in the Box Chief Executive Darin Harris said.

Lest anyone be worried about hurting the fast food companies’ margins, R.J. Hottovy, head of analytical research at Placer.ai, told Yahoo Finance: “It really comes down to … repeat visits after the fact. You’re not making money on the value menu. You’re making menu money on the other products, the more premium products, the dessert products, the beverage products that go along with that.”

Health care is like food in that almost anywhere you go you can probably find it. There are fast food restaurants seemingly on every corner, but there also are drugstores and doctors’ offices somewhere near those fast food restaurants. Health care may not quite be omnipresent, but it’s pretty present.

Unlike food, you may not need health care every day — but you are going to need it at some point. It may be a simple visit, it may be a pill a day for a few days, but it could be a mind-boggling array of tests, medications and procedures you never imagined or lifelong care.

In a fast food restaurant, you look at the menu, pick what you want and how much you are willing to pay, but with health care you don’t have such a menu. Someone else is usually telling what you need and dictating how much you’ll pay for it. After numerous “price transparency” efforts in these last few years, you might be able to find some set of prices, but if anyone has ever successfully been able to use them for anything other than the simplest of interactions, I’d like to know about it.

Where Health Care Value Can Lead

Mar 15, 2022• 3

By BRIAN KLEPPER

It seems inevitable that, in the near future, an innovative health care organization – Let’s call it The Platform – is going to seize the market opportunity of broader value. It will cobble together the pieces, and demonstrate to organizational purchasers that it consistently delivers better health outcomes at significantly lower cost than previously has been available.

To manage risk and drive performance, The Platform will embrace the best healthcare management lessons of the past decades: risk identification through data monitoring and analytics, driving the right care, quality management, care navigation and coordination, patient engagement, shared decision-making, and other mission-critical health care management approaches. It will practice care that is grounded in data and science, and is outcomes-accountable.

But The Platform will also appreciate that a few specialty vendors have developed deep expertise in dealing with clinical or financial risk in high value niches – where health care’s money is – like management of musculoskeletal care, chronic disease, maternity, surgeries, high performing providers, or specialty drugs. It will understand that it often makes sense to partner with experts who can prove and guarantee high performance rather than trying to learn to achieve high performance within each niche. The Platform also will realize that simplicity is a virtue, and that bundling specialized services under one organizational umbrella is easier for health plan sponsors to manage and for patients to negotiate than an array of individual arrangements.

Slow Walking to Value Based Care: Why Fee for Service Still Rules

Aug 26, 2020• 2

By KEN TERRY

(This is the second in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)

In January 2015, then Health and Human Services Secretary Sylvia Burwell announced lofty goals for the government’s value-based payment program. By the end of 2016, she said, 85% of all payments in the traditional Medicare program would be tied to quality or value, and 90% would be value-based by the end of 2018.

The government planned to tie 30% of Medicare payments to alternative payment models by 2017, according to Burwell, and hoped to reach the 50% mark by 2018. In March 2016, HHS said it had reached the 30% goal a year ahead of schedule, mainly because of the Medicare Shared Savings Program (MSSP).

More recent data on the value-based-care movement comes from the Health Care Payment & Learning Action Network (LAN), a public-private partnership launched in 2015 by the Department of Health and Human Services. The LAN reported in October 2018 that public and private payers covering 226 million lives, or 77% of insured Americans, had tied 34% of their payments to value-based care. According to the organization, only 23% of total payments had been value-based in 2016.A deeper analysis of the LAN data, however, shows that the vast majority of value-based payments—both in Medicare and in the larger healthcare system—were still limited to pay for performance, upside-only shared savings, and care management fees paid to patient-centered medical homes.