Know these 5 principles of value-based care, because it's here to stay

American Enterprise Institute scholar says that despite all the various attempts to repeal and replace the Affordable Care Act, value-based care and payment model is the clear path forward.

By Tom Sullivan

October 03, 2017

01:27 PM

CHICAGO -- Washington is missing the point on health insurance and it’s not likely that Congress will pass any major legislative changes in the next year.

That’s according to Joseph Antos, a scholar at the Washington, D.C.-based think tank American Enterprise Institute.

“Washington politicians tend to go for the quick, cheap kill,” Antos said here at the HIMSS and Healthcare IT News Pop Health Forum on Tuesday. “The sky hasn’t fallen — but give us time.”

Amid all the back-and-forth over failed bills to repeal and replace or just overturn the Affordable Care Act, however, Antos and other speakers said that regardless of what happens inside the Beltway, value-based care and payment models are the clear path forward because adjusting cost-sharing is likely to drive behavioral changes that lead to better care at lower costs.

“The goal is better health,” Antos said, “not more healthcare.”

To that end, Antos laid out his principles of value during the morning’s opening keynote.

We have to find a way to move from simple-minded fee-for-service.

Instead, the focus needs to be on providing services toward more appropriate utilization.

“We’re never going to be completely free from FFS,” Antos said. “But we want to think of ways to provide payments that promote better reactions, more fiscally-responsible responses to the system.”

Providers have to integrate care delivery.

The days of Marcus Welby, MD, making house calls with an armamentarium holding a thermometer and stethoscope and essentially operating in isolation are over. “Policy makers often live in that kind of past and the fee-for-service system is rooted in that, too,” Antos said.

Healthcare providers must measure cost and outcomes for patients and make big data work.

This can be more simple than it sounds because almost everyone has a phone capable of running some future app that maintains connections to caregivers to help in, for instance, sudden medical emergencies. “That will happen before Elon Musk gets us to the moon.”

The industry has to make ‘doing the right thing’ worth the effort of customers, providers, insurers.

This one applies to just about every aspect of the industry. Trying to convince young people that they need to buy insurance because they tend to be low-cost customers, for instance, is not exactly a good sales pitch for those young people. Likewise on trying to convince patients that if they take certain actions now they’ll be healthier in 20 years. “People cannot act properly if they don’t know how to act,” Antos said. “And this is also a challenge for physicians.”

Policymakers: Don’t lock us into mistakes we’ve already made.

Antos pointed to the ACA shifting authority from Congress to the Executive Branch and efforts to post prices of care services without making them clear enough for customers to actually understand as two recent examples.

“We’re not going to see any meaningful legislation in the next year, no big deals. There will be changes that generate some fixes, shifting the pea under the shells, but we’re not going to see anything big,” Antos said. “Regulation is where it’s going to be at, not legislation.”