Value-based care has had several false starts over the years. But in the next year, several health systems are determined to make progress toward a payment system prizing pay for outcomes over volume.
"Our No. 1 organizational change in 2025 is a substantial shift from fee for service to value-based care," said Danielle Scheurer, MD, chief quality officer of MUSC Health in Charleston, S.C. "While our organization has been on an incremental journey for many years, we are strategically focusing on the people, processes and technology that will accelerate the pace of change. This is for the good of our organization, and more importantly, for the good of our patients and their families."
Healthcare has become unaffordable for many patients even though many patients have some form of health insurance coverage. Dr. Scheurer sees opportunities to control the overall cost of care as expanding access to care.
"No one benefits from high costs and there are so many levers that we need to continue to pull at the federal and state and local level to reduce the overall cost of care," she said during an interview with the "Becker's Healthcare Podcast." "Whether it's diagnostic efficiency, looking at effectiveness models, looking at cost variation, or looking at the cost and distribution of pharmaceuticals. All of those levers have got to be pulled at all levels of healthcare to make an impact, and make it affordable and accessible for normal people to get the healthcare they need and deserve."
Kathy Kelly, MD, market CEO of Kindred Hospitals of Chicago, is also leading value-based care changes to support systemwide growth and include physician alignment with referring hospitals in the market. Why now?
"With that comes a higher quality of care, increased outcomes and a positive patient experience and service excellence," said Dr. Kelly. "Expertise includes improving programs and services in this turnaround, restructuring and start-up of new operations through the building of strong leadership teams with a focus on service excellence, clinical quality and safety, physician alignment, open and direct communication, and metric-based goals."
The technology has also caught up with what health systems need to deliver value-based care. Data analytics and AI-driven solutions are available to drive process efficiencies and quickly optimize outcomes. JohnRich Levine, DNP, MSN, manager of surgical services at Bayshore Medical Center in Holmdel, N.J., said a big change for his hospital is designing a culture of agility and predictive excellence by integrating AI-decision support for perioperative services with the ultimate goal of fostering innovation and delivering value-based care.
The hospital is implementing AI solutions to optimize scheduling, resource allocation and other real-time decision-making rooted in actionable data. They're embedding technology into the fabric of the leadership team for more successful collaboration and to predict patient flow and surgical demand.
"This transformation isn't about replacing people, but enhancing their ability to deliver care," said Dr. Levine. "By embracing predictive technologies while prioritizing team empowerment, we hope to model how innovation can support both clinical excellence and sustainable operations."
Addams Health Network and its physician group have decided to participate in an accountable care organization, like many other systems. However, they are attempting to make the switch without adding any full time employees to administer the program.
"That is not flippant in any way. It is a long-planned and strategic decision several years in the making," said Nicholas Nussbaum, MD, director of medical affairs and community services at Adams Medical Group. "We have intentionally built into workflows and staffing models the various aspects of data collection, reporting, etc., in such a way that quality, tracking and reporting should be everyone's job, not just one or a few."
The change will be a big shift for the health system, located in Decatur, Ind. While many other community and rural health networks are struggling, Adams has found a unique path forward to continue delivering services to the community.
"Ambitious? Yes. Crazy? Maybe, but 2025 will be the year we find out," said Dr. Nussbaum. "Moving from the planning to the execution phase of the project will definitely be a change though, likely our biggest for 2025."