Last week, the Health Care Transformation Task Force reported that its members had 52% of their business in value-based payment arrangements at the end of 2018. That's up from 47% for 2017 and headed in the right direction toward the Task Force's goal of 75% in value-based arrangements by the end of 2020. However, value transformation is not proceeding as quickly as many would like. The reasons why are worth exploring.
First and foremost, fee-for-service remains very lucrative for many providers, so why upset the status quo? While Medicare deserves credit for leading the way in innovation, the financial benefits of its alternate payment models are limited while the investment required to build needed infrastructure is substantial. In a nutshell, not enough pain in fee-for-service and not enough gain to cross over to value-based models.
Value-based models are intended to put individuals at the center of care delivery, but the reality is that most healthcare consumers are not seeing the benefit of value-based payment as an alternative to fee-for-service. Instead, they are understandably focused on immediate issues of affordability, including the rising cost of insurance, the impact of high-deductible health plans, and surprise medical bills, all of which are taxing every demographic of society and impeding access to care. While many agree that consumerism needs to find its way into healthcare to create a better customer experience, the basic affordability question dwarfs that consideration.
In a perfect world, it would be employers as purchasers of healthcare that could band together with their employees as consumers of healthcare to better drive the market to value. With task force members reporting self-insured health plans approaching 80% of their book of business, it's the purchasers that have the most to gain by pushing for value-based payment and care delivery.
But for competitive reasons and employee satisfaction along with skepticism about cost savings, employers have not reached their potential in being a leading market driver. If an employer has already rolled out a high-deductible health plan, the employer may be hesitant to offer a value-based benefit designed around a high-performing network that may not include an employee's preferred doctor. The hydraulics of all these factors tend to result in inertia on value for many actors.
However, the story is not all negative. While the early-mover problem is still a reality, many industry leaders have moved and are deep into value transformation. They are getting ahead of the care-delivery trends of more care given in ambulatory settings than inpatient ones, more focus on wellness than sick care, and more incentives for patients to engage and be accountable for their role in their care. The healthcare system has begun to place greater emphasis on the social determinants of health that affect patient well-being and is beginning to take a greater role in facilitating interventions to help meet changing social needs, especially with vulnerable and disadvantaged populations.
Vanguard organizations like those belonging to the task force have made the right investments and know that to really transform, organizational commitment needs to be there for the long haul. They know that both the private sector and the public sector must jointly do their parts to drive change. They understand that consumers and patients need to be educated and supported in order to learn about and realize the benefits of value-based care. They also recognize it would be easier to stay with the status quo, yet they still are drawn to the imperative to change. Climbing a mountain is always challenging and change is never easy. Yet success in the face of these odds will be that much sweeter and will lead to a better healthcare system that our country so desperately needs.