Despite large-scale efforts and various incentives, value-based care adoption has been iterative, and inconsistent, and has yet to produce industrywide transformation.
Becker's Hospital Review recently spoke with Bill Nordmark, president and CEO of Enlace Health™, about the current state of value-based care in the United States, how value-based care is evolving, and expectations for the future.
Value-based care can't be delivered on an infrastructure optimized for fee-for-service
"Some employers have seen their health plan costs increase between 10 and 30 percent year over year," Mr. Nordmark said. To better manage and controls these costs, "They are looking to different models like value-based care."
He continued, "Other factors driving interest in value-based care include the desire for greater health equity and increased awareness of social determinants of health. Despite these factors, value-based care hasn't gained significant traction because the infrastructure needed to consume and pay for healthcare services is still designed around a fee-for-service care model."
Enlace Health's thesis is that until there are changes to the core infrastructure of the healthcare system — which is used to manage the payment and delivery of all services — payers won't be able to fully implement value-based care, and providers and patients won't be able to derive significant benefits from the VBC model.
Part of the problem resulting from today's infrastructure is lack of real-time data. While more organizations are attempting to manage different levels of risk under a value-based arrangement, they are challenged by operating with information that is six to nine months in arrears.
"Imagine if people bought airline tickets in the same way that they pay for healthcare," Mr. Nordmark said. "You wouldn't pay for your ticket in advance. Instead, when you landed, you'd get bills for your snack, using the restroom, checking a bag and interacting with the flight attendant. On top of that, you'd have to pay an airport usage fee that costs thousands of dollars. If we can fix healthcare at the core, we can open the world up for consuming and paying for care in a completely different way."
Enlace Health is transforming healthcare through a patient-centered ecosystem
Enlace Health has created a patient-centered ecosystem that seamlessly connects payers, providers and technology partners. The ecosystem enables value-based care by driving coordinated program design, analysis, implementation and administration.
Through Enlace Health's prospective episode programs, surgeons in multiple markets publish a price for a specific episode of care. "When a patient walks in the door, they know upfront what their knee replacement will cost," Mr. Nordmark said. "They don't pay anything downstream for that service. The surgeons look at procedures like a knee replacement as a continual episode — just like buying an airplane ticket and traveling. Changing the healthcare system infrastructure at its core makes this type of prospective payment model a reality."
Mr. Nordmark compared Enlace Health's approach to the credit card industry. When Diners Club cards first came out in 1950, for example, transactions were based on paper receipts with carbon copies. It wasn't until processors like Mastercard and Visa came on the scene that a richer technology ecosystem developed and transformed the core of the credit card industry. Today, innovations like Apple Pay, PayPal and others have grown out of the ecosystem developed by Mastercard and Visa.
From a payer perspective, Enlace Health is committed to meeting the industry where it is. "If you ask payers to change their business processes, you won't be successful," Mr. Nordmark said. "Enlace Health provides the technology that bridges the current world of manual, non-integrated, non-value-based healthcare drivers into an automated, value-based, open ecosystem. By fixing the core, it becomes easier to add value-based care episodes, social determinants of health, health equity, risk arrangements and more."
In the connected, value-based care world of Enlace™, quality care and efficiency are rewarded instead of volume. Patient and provider experiences look very different than they do today. Patients shop for care knowing in advance what the price is. Providers focus on practicing medicine and their patients’ needs without worrying about collecting payments.
"In the long run, value-based care will empower providers, allowing them to spend their time driving value for patients that in turn will reduces costs, improves quality, and increases the total value of the experience," Mr. Nordmark said.