Does value-based care need rebranding?

Sept. 13, 2023 / By Steve Delaronde

Everyone wants quality at a fair price. This is the definition of value. However, when it comes to health care, value may not be the term that resonates most with patients. What about convenient, caring, competent or patient-focused care? A trusting relationship with a provider may be most important to a baby boomer managing a chronic illness. A conveniently located clinic or quick digital access to a provider may be the priority for otherwise healthy millennials who are addressing acute symptoms or injuries. Would value-based care become more widely accepted if it wasn’t called value-based care?

While a value-based payment (VBP) model has existed since the 1960s, the concept became more widely accepted when Michael Porter and Elizabeth Olmsted Teisberg introduced the term “value-based care” in 2006. The Centers for Medicare & Medicaid Services (CMS) launched the Medicare Improvements for Patients and Providers Act (MIPPA) in 2008 to “reward health care providers with incentive payments for the quality of care they give to people with Medicare.” When the Affordable Care Act introduced compulsory value-based payment initiatives and accountable care organizations (ACOs) for Medicare in 2010, the current value-based care movement took a big step forward.

While some VBP programs have produced positive outcomes, others have had disappointing results. Patients are presumed to be the primary beneficiary of value-based care. However, most health care consumers aren’t even aware that they have been assigned to a value-based care program. A 2021 and 2023 survey of EmblemHealth members revealed that only one-quarter of respondents had heard of the term “value-based care.”

Since primary care is the typical gateway to the health care system, it would seem necessary to engage primary care providers in value-based care. However, a 2022 Commonwealth Fund survey of primary care physicians found that fewer than half report receiving any value-based payments. It is important to understand which stakeholders are actually benefitting from value-based care, and it isn’t always the patient.

Just as hospital-based ACOs need to engage and reward the physicians they employ meaningfully, patients need to know when they are included in a value-based care payment program and understand its benefits. Most value-based care programs do not sufficiently offer patients price transparency, financial incentives, shared decision-making, or the ability for health care consumers to enroll rather than be assigned to a program. VBP models primarily exist as an agreement between an insurer and a provider, leaving the patient on the periphery.

Given the impracticality, and in most cases, the inability of patients to price shop for health care, perhaps the patient experience should be emphasized over the “value” of health care services. Also, the experience that patients want is not uniform and many of the differences are based on the patient’s age and the type of care they are seeking. Value has become an overused and ambiguous term, while “patient-first” or “quality-focused” care may better describe the patient’s goal when engaging with the health care system. Patient-focused care also sends the message to both payers and providers that the goal of health care is to help patients get well or manage their health conditions, and not simply replace volume with value.

Steve Delaronde is senior manager of product, population and payment solutions at 3M Health Information Systems.