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How does payment model impact cost and outcomes of care in the US
Do you agree with this position statement?
The traditional fee-for-service payment model which has dominated the US healthcare industry almost since inception is at the root of the high cost of healthcare, the poor outcomes and the high rates of physician burnout (I prefer the term moral injury) in US healthcare. Why? Misaligned incentives.
US healthcare is the most expensive in the world, and yet our outcomes are the lowest in the developed world and suicide rates are the highest for physicians in the US than for any other profession.
In a fee-for-service world, providers of care are only paid for a transaction: a clinic visit, a consult, an admission, a procedure. That means that we get paid more the sicker our patients are and the more transactions we complete on those sick patients. The problem is that this payment methodology only compensates for healthcare – which most studies have shown has only a 10% impact on an individual’s overall health. This payment model mostly ignores 90% of what influences health: genetics (30%), and the constellation of social determinants of health: environment (5%), personal behaviors (40%) and other social factors (15%).
In a true value-based payment model, a per-member-per year lump sum payment, we are “paid” more the healthier we keep our patients! In this model, our incentives are aligned with health, and we look at all factors to keep each individual as healthy as possible. In this payment model, the social determinants of health, which impact 60% of a person’s overall health, are placed front and center. In this payment model physicians (and thus healthcare organizations) are incented to care for the health of the entire patient and not just incented to generate more income (RVUs) and are therefore kept morally whole.
68 months ago
5 answers
68 months ago
This is a well established perspective. To preface, however, ones zip code is a greater indicator of health and life expectancy than ones genetic make up.
That said, I agree in large part as the evidence is clear, and shocking! Two positions come to mind that underscores Brian Patty well articulated point of view, moreover, (1.) “The economic burden of health inequity (John Hopkins and University of Maryland School of Public Health et al, which suggests health disparities may cost the US $1.24 trillion over a three year period, and (2.) 5% of US healthcare consumers, namely, At-Risk populations of the poor and Medicaid, are proven direct cause of what is arguably a $1.7 trillion opportunity to slash spending. Assuredly there is a measure of overlap between these profound social influences data points.
Therefore, something is wrong to be candid. The issue is a matter of paradox in both clinical health care delivery and social services, moreover, once the patient leaves the confine of hospital walls, and or community partner organizations there is a significant breakdown in patient centered care, care coordination, and continuity of care. In effect the patient of high risk underserved communities is seemingly abandoned to the fates of their environment and [unaddressed] social determinants of health.
As consequence to this avoidable travesty patients return back to hospitals seeking resolution to not clinical but rather unmet social needs. This issue goes beyond shallow debates of free market system therory, which has done little to nothing to meaningfully circumvent avoidable catastrophic health expenditure, over utilization, and waste. So, an alternate healthcare delivery system must be architected, and it must make priority physical reaching into the patient environment, track the whole patient journey, proactively identifying further social influences, and addressing as fully as is possible the sum of social determinants.
Whether behavioral health or other high cost modalities and comorbidities there are no absolutes in matters of resolving the issue of social determinants and its affect on total cost of care. Nevertheless, the evidence is clear that US healthcare delivery systems, and healthcare policy makers can and must do more. The ROI and Real Value of such solutions will payback over and over again for generations to come.
68 months ago
Supply-Demand Economics
When a third party pays, quality goes down and costs go up-Axiomatic.
68 months ago
New Definition and Rule:
Any reimbursement not tied to volume will be called "Payer-Profit Based Reimbursement" (PBR) not "Value-Based Reimbursement" until such time it is PROVEN that said reimbursement materially improves outcomes and/or cost FOR PATIENTS.
Who made "Value-Based" the default label for any reimbursement that is not tied to volume? hmm I wonder.
64 months ago
Top 10 Most Likely Causes of Death in the U.S. and their lifetime odds based on 2017 data
1. Heart Disease: 1 in 6
2. Cancer: 1 in 7
3. Chronic Lower Respiratory Disease: 1 in 27
4. Suicide: 1 in 88
5. Opioid overdose: 1 in 96
6. Motor Vehicle Crash: 1 in 103
7. Fall: 1 in 114
8. Gun Assault: 1 in 285
9. Pedestrian Incident: 1 in 556
10. Motorcyclist: 1 in 858
Source: National Safety Council
64 months ago
