Dr Dennis P. Scanlon Outlines Surprises in the Move to Value-Based Care

I think the biggest surprise in the move toward value-based care is that there’s a lot of organizations sitting on the fence in limbo because the payment mechanism is still built off a fee-for-service chassis, said Dennis P. Scanlon, PhD, professor, Health Policy and Administration, and director, Center for Health Care and Policy Research, Pennsylvania State University.

Transcript

Have there been any surprises in the move to value-based care?

I think the biggest surprise, from my perspective, and this is confirmed in a project I’m currently doing with a lot of delivery systems where we are talking to delivery systems across the country and we’re asking them sort of where they’re headed, why they’re head in that direction, what their strategy, and value-based care is a big component of that. I think the biggest surprise is that there’s a lot of organizations sitting on the fence in limbo, quite frankly, because the payment mechanisms, as Suzanne F. Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, said this morning in the keynote address, is still built off a fee-for-service chassis.

And when you have fee-for-service or discounted feed-based reimbursement, the incentive always will be more volume. Value-based purchasing or value-based approaches tries to turn that on its head, and it tries to look at what’s needed in terms of care, what’s appropriate care, and thinking about managing utilization appropriately and focusing on the provision of high-quality services.

So, I think that for all the hype and all the talk and all the goal setting around value-based reimbursement, I think, early on, people felt that they kind of had to at least think about it or move in that direction, but then I think very quickly they realized that, “we can still sit on the sidelines, let others be the innovators, and when the payment really changes, then we’ll move in this direction.”

Now, the only thing I would add there is that it does vary market to market and in interesting ways, and I would guess that this is a surprise as well. I won’t name the names of delivery systems, but let’s say they’re some very prominent, high-quality, internationally well-known delivery systems in this country that have absolutely no interest and have decided that they don’t need to move to value-based care because in their market place, they have cache, they have clout, they have clout with payers, and there’s just no need for them to sort of move away from fee-based reimbursement. You have other markets where a move towards that is happening more rapidly, so a lot of this ultimately comes down to the principles of supply and demand and how things are playing out in the market place.