Future Trends in Value-Based Care in Healthcare

There's a blueprint to delivering value in MSK care: First, determine which patients are appropriate for non-surgical treatment and which would benefit from surgery. Surgical candidates should be separated into those who are ready to go and those who would benefit from optimization of modifiable risk factors. Many conditions can be initially managed with high value, evidence-based conservative treatment. This has been a big area of focus for virtual/alternative MSK solutions as it's the fastest and easiest way to prove ROI. But steering patients who would benefit from a procedure away from surgery doesn't always make sense clinically (though it may support your value prop). If the ultimate outcome is going to be surgery anyway, forcing conservative measures wastes time/money and makes the patient suffer unnecessarily. That's not delivering value. Value is making sure surgical patients get connected with transparent, high-quality, cost-effective care. The nuance, and where the magic happens, is having the knowledge and experience to bridge the gap between protocol driven treatment and personalized, patient-specific care. Too much of the former dogmatically leads to cookbook medicine. Too much of the latter creates a Wild West scenario where anything goes. The future is creating an MSK medical home that helps PCPs appropriately evaluate and manage conditions in the primary care setting while serving as a conduit to high performing specialists. Reduce variability. Avoid low value interventions. Optimize, engage, and educate patients. Collect data and evolve treatment protocols/algorithms over time. Establish centers of excellence based on outcomes, not branding and reputation. As we shift toward condition specific MSK VBC, the winner will be the one who can successfully guide patients along the entire journey while interfacing across the care continuum (likely while taking on risk). Threading together the disparate parts is not easy. It takes deep subject matter expertise and an understanding of how the system works (and doesn't) -- which is probably why we haven't seen anyone grab the brass ring yet. #medicine #msk #valuebasedcare #vbc #healthcare #health #healthcareinnovation

It’s great to see the Business Group on Health 2024 employer survey validate what we are seeing in the market: - Employers are demanding better quality care and  - They are leveraging the Centers of Excellence model as a key tactic to ensure it happens. If you dig deeper, the crux of this year’s report reveals how the market is shifting to a value-based COE model. Most employers offer at least one COE, and cancer and musculoskeletal COEs are expected to have double-digit growth in the next three years - in line with being the highest spend categories. We’ve had an up-close view of this trend as COEs have continued to gain solid traction year-over-year. This is thanks to sophisticated employers who understand that to achieve the triple aim of containing costs, price transparency, and improved outcomes, they need to start with ‘quality’ and COEs are the key enablers. https://bit.ly/3YJ6zdj #healthcarecost #employeebenefits #cancercare #selfinsured #CarrumHealth #valuebasedcare

As we step into 2024, I've been reflecting on the predictions swirling around substance use care. It's evident that this area will be a primary focus, and what caught my attention the most were the discussions on value-based care in SUD work. How will value-based care unfold in SUD treatment? It's clear that mental health's unique landscape requires a tailored approach. Having specialized in substance use disorders and primary care mental health integration during my fellowship, I understand the complexities. My fellowship journey, specializing in substance use disorders and primary care mental health integration, highlighted a crucial aspect – relapses will happen. There are no if’s, and’s or but’s about it.  Did you know it takes at least 14 months of abstinence for your brain to return to a healthier baseline? This underscores the need for a holistic approach, emphasizing the mind-body connection. Exploring ties between mental health treatment for SUD and physical health outcomes (such as improved cardiovascular health, diabetes outcomes, and oral health) could be a game-changer.  But how do we hold SUD providers accountable for outcomes before they materialize? This is a question that requires thoughtful consideration as we navigate the transition to value-based care. It's a paradigm shift that will require a delicate balance.  Transitioning to value-based care is not just a strategic move; it's a lifeline for SUD patients who often require extended treatment periods. Research consistently shows that the longer a patient engages in SUD treatment, the more significant the improvement. I'm genuinely excited about the potential of value-based care in SUD treatment. What makes me even more optimistic is the prospect of involving all players in the ecosystem – clinicians, payors, patients, policy-makers, and more – in shaping this path forward. Together, we can ensure that our journey toward value-based care is not just a change tied to money but a collective win for mental health care. Looking forward to navigating this transformative path together! ✨ #MentalHealthCare #SubstanceUseCare #ValueBasedCare #HealthcareTransformation

Consider this: For decades, health reformers have been touting the move to "value" -- paying for outcomes and not doing more procedures and tests. So how is it going? My latest piece, co-authored with Daniel Shenfeld and Amol S Navathe, is out now in JAMA where we look at the promise -- and challenges -- of value-based payment (VBP) in health care delivery. Our key insights: 1. VBP success stories highlight its feasibility and promise: Programs like the Comprehensive Care for Joint Replacement (CJR) Program saved $61.6 million over three years, and the Medicare Shared Savings Program generated over $8 billion in net savings with significant financial benefits for primary care physicians and high-quality performance 2. Challenges with design and adoption: Few healthcare payments use VBP models, with most still on FFS. Transitioning is complex and requires different management. Effective risk adjustment is needed to ensure real savings, not just improved documentation. 3. The path forward: Accelerating VBP adoption requires coordinated efforts and better support for providers, including accessible financial data and affordable tools. CMS should promote low-cost solutions and require commercial payers to use standard data formats. Paying for value rather than more health care is without any question a wise approach. Overcoming the challenges with VBP requires coordinated efforts and better support tools for providers. For more on how we can build a health care system that values outcomes over volume, read our article linked in the comments. #HealthcareInnovation #ValueBasedPayment #JAMA #HealthcareonLinkedIn

In 2023, the #healthcare industry saw continued conversations around #AI, industry-disrupting drugs, and staffing shortages – so what will we see in 2024? Here are 4 of my #predictions for the upcoming year: 📱The technology conversation will continue to be driven primarily by #generativeAI and #ChatGPT, and we will begin to get clearer answers about regulatory needs and the impacts AI is having and will continue to have in healthcare. 💊 The spotlight will move away from pop culture-driven weight loss prescriptions (hopefully) and instead focus on treatments and preventions for cognitive conditions like dementia and Alzheimer’s that impact millions of individuals in the US and around the world. 🧑⚕️Staffing shortages in healthcare will persist and could even potentially worsen, so we must find ways to dramatically increase the number of healthcare workers—and equally focus on delivering care in new and different ways, supporting and easing their burden—to ensure maintaining quality patient care. 💲#ValueBasedCare will continue to gain traction in our system and eventually outpace the Fee for Service (FFS) model. Frontline caregivers and those working behind-the-scenes will increasingly examine our roles and how we impact value in the work we do. The landscape supports this claim as well – the Centers for Medicare & Medicaid Services want 100% of beneficiaries operating according to Value-based Models by 2030, especially as our society addresses the continued aging of our population. There might even be some green space for AI and technology in helping us make this transition… Stay tuned for January’s edition of my #SimplifyingHealthcare newsletter, where I’ll dive deeper into more of my healthcare predictions for 2024. 💡 #BigIdeas2024 #HealthcareOnLinkedIn #TopVoice