Look, bottom line, value-based care has to be the future of health care delivery in this country. That’s just inarguable at this point. Nobody disagrees except for health care industry stakeholders trying to reap as much reward as possible while the going is good. And they’ve been really successful with their reaping thus far.
Here’s the thing, though: There’s speculation that health insurance premiums may go up, like, 4% to 40% next year if the status quo remains the status quo. Is this the moment when we all start to get real about value-based care? Not because it would be a nice thing to get up and running, but because we have to. Health care costs are already too high in this country. You can’t just add 40% and think that somebody’s gonna find that kind of change in the bottom of their pocket, which has already been turned inside out. But also because on the provider side of the equation, it’s less risky.
Here’s what I mean by less risky: All of those health systems struggling right now because of the decrease in elective procedures—if they had all had a significant portion of their revenue derived from value-based agreements where they were contracted to take care of populations, they’d all still be getting paid their global/capitated payments right now and actually able to take care of patients who need care instead of sitting on the sidelines watching their bank accounts dwindle.
In this health care podcast, I speak with Eric Weaver, who is the newly minted executive director of the Accountable Care Learning Collaborative based in Utah. We talk about how life could have been a lot different for PCPs and also specialists, by the way, and health systems had we lived in a value-based world instead of an FFS (fee-for-service) one. Considering that this pandemic might consist of waves that extend for months if not years, this might be a call to action for providers to get meetings set up with payers, like, right now to switch up payment terms into value.
But it’s also a call to action for purchasers of health care like employers and commercial carriers. When I was talking to Guy Culpepper, a PCP, in episode 272, he really wants value-based contracts; but he can’t get them alone. Purchasers and payers have to be willing to come to the table and offer them.
So come on, everybody! Let’s belly up to the conference room table—or your little Zoom Brady Bunch box, as the case may be. Now’s the time to really flip the switch to payment models that work for patients and enable physicians at the same time to provide the kind of care that’s in alignment with their values.
One acronym heads-up in this conversation that I have with Eric Weaver coming up: APM stands for advanced payment model, which is, at its simplest level, a kind of value-based payment model.
You can learn more at accountablecarelc.org. You can also connect with Eric on Twitter at @Eric_S_Weaver or on LinkedIn.
Eric Weaver, DHA, MHA, is nationally recognized for his work in payment and delivery transformation. He is the recently appointed executive director of the Accountable Care Learning Collaborative (ACLC), a nonprofit organization founded by former Secretary of Health and Human Services Mike Leavitt and former Administrator of the Centers for Medicare and Medicaid Services Dr. Mark McClellan. With a mission to accelerate the readiness of health care organizations transitioning to value-based payment, the ACLC has defined the standards for high-value organizations and the workforce skills and competencies needed to advance value-based care.
Dr. Weaver has been recognized for his contribution to the health care industry by receiving the ACHE Robert S. Hudgens Award for Young Healthcare Executive of the Year and the Modern Healthcare “Up & Comers” Award in 2016. Prior to assuming his new leadership role with the ACLC earlier this month, Dr. Weaver was a senior vice president for Innovista Health Solutions, a population health MSO, and was the president and CEO of Austin, Texas–based Integrated ACO—one of the more successful physician-led accountable care organizations in the country.
For more information on Dr. Weaver and his vision for the future of the ACLC, you may access this video. If you are a provider organization looking to succeed in value-based care, you can obtain a free membership to the ACLC at accountablecarelc.org/join-us.
03:23 Is this pandemic an inflection point for value-based care?
04:10 “If United Kingdom built their National Health System post-World War II, why can’t we rebuild ours?”
04:40 “If it’s ever gonna happen, it’s gonna happen now. I just think we need to wake up.”
05:04 Do volume decreases equal payment decreases?
06:10 Where value-based care plays into specialty care vs primary care.
06:21 “There just hasn’t been a value on cognitive services as there has been on procedural volume-based care.”
06:55 “I really think that independents have to be in the driver’s seat here.”
06:59 The possible silver lining in this pandemic.
08:07 Why it’s mostly about economic incentive … with a couple of caveats.
12:21 More or less hospitals when this shakes out?
14:01 “There has to be some standard of measurement for quality, and we all know that.”
17:00 Where the patient experience plays into the value-based care equation.
21:54 “We have to be thinking about the consumer and the patient.”
22:25 Where employers land in this equation.
25:14 What happens to the value-based care measures that were in place and aren’t anymore?
27:20 How carriers buying providers impacts value-based care.
29:54 “I really think we’re … [looking at] a new normal.”
30:49 “We have to go all in.”