Lili Brillstein Explains Why the Transition From Fee-For-Service to Value-Based Care Takes Time

The shift from fee-for-service to value-based care requires collaboration, communication, and coordination across the care continuum, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

Transcript:

Do you agree with the assessment that the transition to alternative payment models and value-based care has been too slow? Why do you think the transition has been slower than some expected?

The move from fee-for-service to value-based care is really evolutionary and it does take time. I think there are a lot of people who thought you could go right from fee-for-service to risk-based, value-based care models. I think that's not exactly the case. In fee-for-service, the focus is really on incremental units of care and cost of care. It has led to spiraling costs, but it's also led to very disjointed care. In value-based models, where we sort of shift the focus to patient outcomes, and we really look at instead of all the care that's rendered by one doctor, as we do in fee-for-service, we look at all the care that's rendered to one patient, but across the full continuum.

That shift requires collaboration, communication, coordination across the continuum of care that really is not what fee-for-service is about. It's not how that model works. It's a complete change in not just mindset, but also the way people interact, the way different stakeholders interact, and what the focus needs to be. I'm a very big proponent of starting any of these models in sort of a no risk way, meaning don't shift the risk yet to providers until everybody has kind of figured out what are the new roles, how do we all need to interact. Value-based care, unlike fee-for-service really relies on building those relationships, identifying who are the best, most efficient partners to help take care of the patient in a no risk model.

I always say the payers aren't at any greater risk if they launch a no risk model. The providers aren't going to suddenly start performing more poorly simply because they're given an opportunity to earn more revenue. What it does is it allows the playing field to be leveled a little bit, the fear on the part of the providers is removed. Everybody's free to work together to build these models. I think it takes time. These have historically been adversarial relationships. It requires time to cultivate new relationships, new ways of thinking.

Then it also takes time, once you start to build the relationships, it takes time to figure out, by studying the data, where are the opportunities, where's the variation in the care and the cost of care that needs to be addressed in the model. Then it takes time to develop the protocols that will be used to address them, and it takes time to implement them, and then it certainly takes time to see the impact of them. I think that's a really major reason why it has taken longer than I think some people anticipated.

I think also, the other thing is on the health plan side, the claims and other systems are not built for these models. They all sit on a fee-for-service chassis. The time and investment that is perceived to be required to make these changes is enormous. I say percieved because I think there are ways to use the existing systems to make these models work. We just have to talk about it and figure out together what makes the most sense.