Blog

Why Value-Based Care vs. Sick Care

TL;DR: The U.S has the best “sick care” system in the world, one that’s centered on reactive care rather than preventative care. But it doesn’t have to be that way. Value-based care (VBC) models were designed to begin healing our “sick care” system, yet several barriers prevent its adoption. Most notably, physicians are often left out of the conversation in which VBC solutions are developed. To break down these barriers, physicians can be brought into the decision-making process to ensure that they have a role in creating a solution that aligns with their interests and promotes the best outcomes for their patients.

“Sick Care” in the U.S. 

The United States has the best “sick care” system in the world. Rather than preventing health problems from happening in the first place, most of our medical care is focused on reactive treatments such as medication and surgery.

Due to a stronger focus on reaction rather than prevention, 60% of U.S adults now live with at least one chronic disease, many of which are entirely preventable. Every year this leads to an economic burden of nearly $4 trillion in direct and indirect costs.

One highly preventable chronic disease is obesity. While increased physical activity and a moderated diet can go a long way to combat extra weight – and its 60+ accompanying chronic conditions – obesity in the U.S. is climbing rapidly. By 2030, it’s estimated that roughly half of the adult U.S. population, or ~130 million people, will have obesity.

Prevention is medicine, yet the current healthcare system is overwhelmingly inconsistent, out of touch, and lacking the continuous care capabilities required to intervene in patients’ lifestyle choices before it’s too late.

Patients take notice of this as well. Most patients currently think that their providers aren’t proactive enough in promoting their health before complications arise. According to a survey by West, two-thirds of respondents believed that their provider was more focused on treating illnesses rather than preventing them. 80% of patients also said they would get preventative screenings if their provider recommended them.

While “sick care” enables the pervasiveness of costly chronic disease, it’s a trend that can be reversed with consistent, connected, and preventative healthcare. And patients are expecting exactly that.

The transition to “health care”

The U.S. critically needs a “health care” system that prioritizes the prevention of chronic conditions from occurring in the first place. But where do we start?

One potential solution designed to transition our system of “sick care” into one of “health care” is the value-based care model. Value-based care (VBC) is a type of reimbursement model where payments for health care delivery are intended to correlate with the quality of care rather than the number of services provided.

In other words, rather than being paid for ordering more tests, performing more procedures, and providing other “reactive” forms of care, providers are rewarded for improving their patients’ health using evidence-based medicine.

VBC models use several metrics to define quality of care. These include:

  • Patient outcomes,
  • Use of certified health IT,
  • Preventative care,
  • Hospital readmissions,
  • Adverse events, and
  • Patient engagement.

Under VBC models, providers must track this data and demonstrate improvement over time to collect reimbursements. Designed to improve coordination and increase accountability toward healthcare quality, VBC may have the potential to both reduce the occurrence and severity of chronic disease and match patients’ shifting expectations for more proactive healthcare.

For example, a 2015 report found that VBC models helped reduce hospital readmissions by 8% for Medicare beneficiaries. Implementation of another type of VBC model, patient-centered medical homes (PCMH), led to a 15% decrease in emergency room visits for a Colorado-based PCMH and increased YOY quality scores by 10% for a Maryland-based PCMH.

VBC models also enable significant cost savings. Accountable care organizations (ACOs), a type of VBC, achieved over $4.1 billion in total Medicare cost savings in 2020, up from $417 million just 5 years prior.

Barriers to value-based care adoption

Although it has some potential, VBC is still relatively new and, as of 2019, only 38.2% of healthcare expenditures flowed through this type of model.

Physicians are particularly cautious about the transition to VBC for a variety of reasons. More than 70% of physicians still prefer fee-for-service models primarily because they do not see the evidence that VBC will lead to better outcomes and they are concerned about its extensive administrative burden.

To illustrate further, one survey found that over 60% of physicians believe it will in fact become more difficult to deliver high-quality care in the coming years due to the following:

  • A more complex regulatory environment
  • Increasing administrative burdens
  • A more difficult reimbursement landscape

These concerns can and do manifest for providers that are spurred to adopt VBC. For example, one program found that most physicians did not see a return on their investment in VBC due to neutral performance or insufficient data.

This occurs not simply because physicians aren’t providing quality care, but as a result of unclear rules and requirements, a lack of resources to adequately track and report data, and little administrative support throughout the transition.

Addressing and overcoming barriers to VBC

Despite hesitation towards certain types of VBC, providers recognize the flaws in the present “sick care” system and therefore the importance of embracing a more comprehensive approach to their patients’ health that focuses on preventative care. If the current VBC strategies aren’t working for physicians, then what is the path forward?

Instead of requiring physicians to tackle an intensive reimbursement overhaul with a lack of strong evidence in favor of it, as well as little to no support to implement it, they can be brought into the decision-making process to ensure that they have a role in creating a solution from the bottom-up, rather than the top-down. This allows physicians to address their concerns surrounding efficacy, simplicity, and return on investment and will result in a better solution that is more likely to be implemented effectively, thus improving care quality and outcomes.

One solution that is both physician-centered and rooted in value-based care is Prescribe FIT. Our full-service remote monitoring and lifestyle health solution serves an extension of orthopedic practices to provide value-based care to patients with zero upfront cost to the practice and very minimal staff involvement. Prescribe FIT significantly reduces the administrative burden associated with other VBC models while helping practices vastly improve patient outcomes.

Conclusion

The continuous climb in preventable chronic conditions signals the need for a new approach to healthcare. VBC as a solution is slow to adopt because it has yet to adequately address the concerns of many physicians. To move forward, healthcare organizations can work more closely with their physicians to build a solution that is aligned with all perspectives, or adopt a solution such as Prescribe FIT, thus leading to better health outcomes for patients.

Published on September 19, 2022