Is the U.S. healthcare industry thinking about value-based care the right way?
No, or at least, not yet, suggested a panel of executives at Columbia Business School's annual healthcare conference in New York City Friday.
“We have to redefine the problem as 'health,'” not healthcare, said Dr. Hal Teitelbaum, the CEO of Crystal Run Healthcare, a multi-specialty group practice in New York, during a panel on value-based care.
Policymakers, executives, physicians and researchers talk about shifting healthcare from a fee-for-service system into a value-based one. They dwell on the necessity of containing costs, as healthcare spending is on track to constitute nearly 20% of GDP by 2025, and mull over ways to reduce spending.
Government and private payers are increasingly negotiating value-based contracts and creating alternative payment models like accountable care organizations, bundled payments and population health models. But the industry is nevertheless concerned that these approaches will cost them.
“The big problem that we have is this idea that it's a zero-sum game and there are going to be winners and losers,” Teitelbaum told Modern Healthcare after the panel. He said he constantly hears people in the healthcare industry who are concerned about losing jobs as a result of value-based payment, who make remarks like, “We don't want hospitals closing all over the place.”
But those fears overlook the purpose of medicine in the first place. “We cannot be doing procedures, admitting people to the hospital, exposing people to radiation, doing the wrong things to preserve employment and to keep hospitals healthy,” Teitelbaum said. “These are not innocuous things we do -- chemo, surgery, imaging with radiation.”
Other panelists alluded to the same problem, as the healthcare industry grapples with figuring out how to provide the right care to patients who actually need it, at the right time.
“Our CFO is on life support and his hair is falling out, because we're killing revenue,” said Dr. Brian Nester, the CEO of Lehigh Valley Health Network, eliciting chuckles from the audience. LVHN has launched several strategies in recent years to improve the quality and value of care, such as population health initiatives that involve deploying seven community care teams of 36 people.
Another telltale sign that the healthcare system's mentality is not yet rooted in value-based thinking is the way it involves patients—or, rather, fails to—in those changes.
“The voice of the consumer has been noticeably absent from value-based care,” Dan McCarthy, COO of Healthfirst, a New York-based insurance company, pointed out during the panel.
The panelists often returned to the subject of waste in healthcare, citing the statistic that 30-50% of care is unnecessary, and therefore wasted. They built on an example, in which 200 patients out of a population of 2,000 are the neediest, requiring constant care.
Although population health initiatives focus on bringing down the costs and improving the quality of care for this most-risky segment of the population, they also shouldn't ignore what happens to the 1,800 people, who need far less care, if any at all.
“Messing around and doing things in people's bodies is not the first thing to think about,” said Teitelbaum. “Doing more is not always the answer; I'm not saying doing less is always the answer. Doing right is the answer.”
