Today’s Conflicting Perspectives in Defining Value-Based Healthcare

In order to address the concept of value in health care, it is important to address a fundamental purpose and mission of health care.

Health care is the relationship
between a physician and a patient in order to achieve patient wellness.

– Bill Bysinger, 2016

If this is the mission, then the objectives should be focused on the patient:

  • Available Care
  • Quality Care
  • Affordable Care

For too long the industry has been focused on other objectives. More focus has been on attempting to lower costs by using software applications for back end systems, creating electronic health records to make physicians more productive, and using these technologies to reduce operational and care staffing. Interesting, but the results have not been what was anticipated. In many cases these systems did not produce real cost savings. The real needs are more adaptive technology, more effective care coverage, more efficient claims and payment processing, and appropriate care coordination through information integration.

Value-Based Healthcare is the latest label for health care that is better than what we have today. However, I submit that there is no one statement for the definition of this new focus for health care of the future. Rather it should be dependent on the contribution of the organization to patient care in specific.

To determine healthcare value, the following should be addressed:

Who Defines the Value?

Value can be defined by the industry, federal government, state government, physicians, hospitals, health systems, health plans, or the real judge…the patient.

What are the Parameters Used to Measure the Value?

Value can be measured by outcomes, claims adjudication accuracy and volume per day, CMS EHR measurements for Meaningful Use, comparisons to Population Health Data in specific geographies, or again the issues most important to the patient:

  • Getting to wellness
  • Access to appropriate providers
  • Health insurance premiums and deductibles

How is Value Achieved?

Value can be achieved through:

  • Process improvement at all levels (plan and provider)
  • Cost containment at all levels (plan and provider)
  • Operational efficiency in health plans (all models), health systems (all models) and providers through data quality, care management and predictable patient outcomes
  • Integrated information
  • Deep collaboration from all plans and providers

Who is the Final Arbiter of Healthcare Value?

The patient should be the final judge of health care quality. Why is the patient at the center of healthcare quality? Because:

  • Wellness is the ultimate measure of health care success
  • Access to care is the proof the healthcare market is working
  • Integrated patient data from all plans and providers is proof the healthcare industry is collaborating

If the industry viewed Value-Based Healthcare in a Patient-Centric Model, perhaps it could be the focus of quality and efficiency, and create the patient confidence that wellness can really be achieved at a fair cost and in a timely fashion.

What does Value-Based Healthcare mean to you?

How do you think Value-Based Healthcare can be defined, measured, or achieved? We’d love for you to join the conversation by posting a comment below.

If you’d like help transitioning to Value-Based Healthcare, read about HCIM’s Strategic Consulting services.

Dr. Bill Bysinger

Bill Bysinger, Ph.D., MBA
HCIM Sr. Strategic Adviser

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About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.