A potential snag in the value-based care shift

The U.S. healthcare system's transition to value-based care might be slowed by current financial conditions, according to an October 2023 report published in NEJM Catalyst

In June, 915 members of an NEJM Catalyst Insights Council — composed of clinicians, clinical leaders and executives at organizations directly involved in care delivery — were surveyed about their workplace's financial health. Half of the 543 U.S.-based respondents are employed by hospitals, while the rest work for health systems, clinics, physician organizations or other healthcare facilities. The report was co-authored by Baligh Yehia, MD, president of Philadelphia-based Jefferson Health, and Alice Pope, CFO of Falls Church, Va.-based Inova Health System.

Of the U.S.-based respondents, 61% predicted that current financial conditions will have a negative or strongly negative impact on the value-based care shift. 

One factor impacting hospitals' finances — and thus, value-based care — is declining reimbursement rates, a vice chair at a nonprofit teaching hospital said in the report. 

"The fundamental problem is accepting whatever the reimbursement reductions are," the executive said. "It is patently unsustainable to have unrelenting decreases in reimbursement coupled with significantly increased overhead. Value-based care promotes cherry picking and jettisons any patient with significant chronic disease that requires expensive treatment to academic medical centers. Venture capital and corporate medical chains are already targeting this market."

COVID-19 also set the movement back, another healthcare executive said in the report. 

"The pandemic moved focus of health systems entirely from value-based care to primarily meeting acute illness outcomes and therefore, the economic stressors associated with increased hospitalizations and their aftermath," the executive said. "Generally, if health systems focus on maintenance of health by integrating value-based care instead of the fee-for-service model into their practices in various populations, then high-intensity, high-cost resources including personnel could be better allocated to providing care to the sickest."

In order to facilitate the transition to value-based care despite challenging market conditions, health systems should focus on attracting a new patient population base, according to a clinician at a for-profit university in the U.S. 

"If we are truly adopting a value-based health care model, we must incentivize prospective patients in a way that motivates them to establish care," the physician said. "Volume of GP [general practitioner] visits must increase to cover the reduction of high-cost procedures."


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