The US Cannot Afford to Put Off the Move to Value-Based Care Any Longer, Panelists Say

The move to value-based care has not happened as quickly as expected, and panelists during a keynote session at the 15th Annual World Health Care Congress (WHCC) discussed how a shift in care delivery and more data are helping to make value-based care a reality in the United States.

While provider organizations and payers are considering how best to give patients better access to care that will make them better and healthier, the reality is that actually effecting change is hard, explained Karen Springer, president of healthcare operations at Ascension Healthcare. For instance, in Nashville, Tennessee, Ascension has realized that it hasn’t made as much of a difference as it thought it would for the patients with the highest risks or with diabetes.

“We haven’t done what we need to do,” Springer said. “While we’re helping people, we’re not helping communities get better.”

Matt Wallaert, chief behavioral officer at Clover Health, approaches the challenge from a different angle. As a behavioral scientist, Wallaert looks at motivational systems and getting patients to make healthy choices.

“We don’t even ask people what they want,” he said. It’s not enough for providers to focus on getting patients their flu shot if their patients want help exercising. Getting to a motivational system of healthcare means meeting people where they are.

Motivating people, he added, doesn’t have to be rooted in monetary incentives. Wallaert noted that at WHCC, he witnessed people standing on the escalator when there were steps right next to it. One way to motivate people to take the steps instead could be to hand out a dollar to each person who takes the stairs, but another way to motivate people could be having a sign that identified the escalator as “this way to a heart attack” and the stairs as “this way to healthy.”

Healthcare organizations need the ability to think more creatively to deliver value, but the payment isn’t there yet. According to Phil Jackson, CEO of health plan products at Sutter Health, capitation provides an opportunity—the providers are accountable for a population and the payment incentivizes them to think creatively about how they deliver care.

He added that too often there are only incremental improvements based on pay-for-performance or episodes of care models.

“We need a much faster, more accelerated level of transformation,” Jackson said.

At Amedisys, a home health and hospice care provider where Paul Kusserow is president and CEO, there is a shift away from hospitals being the center of care. Hospitals that only see a patient once every few years when something really bad happens don’t have adequate data, he said, but Amedisys has the data to predict the likelihood that one of its patients will end up back in the hospital.

More people don’t want to be in hospitals and institutions as they age, and care is starting to be centered on the home, Kusserow said. And the home is where all the data is. The question now is how does that data get extracted and used?

The challenge with data is that it is a 2-way street, Wallaert said. Clover Health is a new player in the industry and it has a lot of data, but Clover needs providers to be ready to receive that data. He explained that too often, they can go to a hospital with information about the patient, but the hospital doesn’t know what to do with that data once it has it. “The gathering [of data] is only one half of the equation,” he said.

The panel also discussed social determinants of health. As a clinically integrated system of care, Ascension has moved beyond the hospital-centric model of care Kusserow mentioned. Ascension has multiple sites of care in the community that are integrated, so a patient can come into the system of care through any avenue of care.

She added that “It takes a community to deliver care,” and that Ascension believes that is their responsibility. However, there is still a lot of coordination that needs to happen to deliver care that addresses social determinants.

“For most of our patients who are ending up in our care, it’s around their social determinants,” Springer said. “We really haven’t understood what’s going on in people’s lives.”

At the end of the session, one audience member pointed out that a lot of the conversation taking place during the panel echoed conversations happening in 1995. So, the audience member wanted to know, why are things different this time?

Some of it is the data. Kusserow said that the data are completely different now and can be understood better. Springer said that some of these things that have been discussed have just taken a long time to roll out.

“I think we’re at a point in time where we’re at today we don’t have any other choice to get this done,” she said. “This country can no longer afford to keep going on the path that we’re going on. It’s our time for ownership.”