The Covid-19 pandemic has exposed weaknesses in health care systems around the world, and the U.S. is no exception. Observers cite a wide range of issues — from underfunded public health departments to inequitable access to care, to high levels of underlying chronic conditions that worsen outcomes — that need to be addressed to create a more sustainable post-pandemic health care system.
One potential change that is attracting increased attention is the transition from a traditional fee-for-service system to value-based care, a delivery model in which providers are compensated based on patient health outcomes rather than being incentivized to perform costly procedures and tests.
Of course, value-based care is not a new concept, and while many organizations have previously expressed interest or taken initial steps in this direction, the model has been slow to gain traction in the U.S. Why does the pandemic add to the urgency?
First, many providers are facing unfamiliar financial insecurity, as fees from routine visits and elective procedures have plummeted due to cancellations and shifts in resources — creating an opening for the consideration of new models. Second, industry experts predict a health crisis after the pandemic recedes. Over the past year, fears of exposure to Covid-19 have led many individuals to avoid or delay preventive care and screenings, meaning that significant rates of late-diagnosed health issues (and consequently poorer outcomes) can be expected. At the same time, the pandemic has created an additional ticking time bomb in the form of harmful habits and escalating chronic disease risk due to factors such as reduced physical activity, unhealthy diets, excess alcohol consumption, and increased stress and depression.
Self-insured companies and payers are already struggling under the massive burden of managing chronic conditions. If nothing changes, the coming tidal wave of health care costs will be overwhelming.
While broader efforts will be required to address the social determinants of health, a shift to value-based care would realign the incentives of providers, payers and patients toward sustainably improving actual health outcomes. To support that transition, the following are three changes that employers, insurers and providers can immediately embrace and implement.
Maximize the use of telehealth
The genie is out of the bottle, and telehealth will continue to be a popular and cost-effective complement to in-person care after the pandemic is over. Providers must continue to offer this option when appropriate. While hands-on care is obviously necessary in many situations, virtual visits are convenient and efficient — and can even be superior in some cases, beyond their ability to significantly expand access to both basic care and specialized expertise. And in addition to virtual visits, digital tools that enable remote patient monitoring can engage patients more consistently and deeply in their own care. These solutions will be a critical component of any value-based care program.
Break down the barrier between physical and mental health. Telehealth has begun to blur the line between physical and mental and emotional health, and this trend should strengthen. Providers need to look at the whole person. Different specialists may be involved, of course, but they must communicate and collaborate. Value-based care requires a team approach (as seen in patient-centered medical homes and accountable care organizations, for example), with extensive data sharing to enable coordination of care and measurement of outcomes. Efforts to reduce stigma and promote insurance coverage of mental health care are gaining ground and must continue. Health is health.
Take a step back and focus on primary prevention. The U.S. health care system as it is currently structured is actually a sick care system, and providers have neither the training nor the time to guide their patients in developing the healthy everyday habits that would help keep them from becoming sick in the first place. Employers and payers have attempted to fill this void with a variety of individual wellness initiatives (gym memberships, meditation classes), but because initial enthusiasm often fades quickly, and the wellness space is notoriously lacking in scientific rigor, many of these efforts are ineffective. To truly improve health outcomes, organizations need to look beyond managing unhealthy people’s chronic conditions and engage in primary prevention via behavior change. A habit change provider can complement the traditional health care team to intervene with at-risk employees, creating sustainable lifestyle changes that proactively alter the trajectory of chronic disease development.
The pandemic has upended virtually every industry, and although many of the impacts are undeniably devastating, negative events can also offer opportunities for positive change, by highlighting existing problems and eliminating roadblocks to new solutions. The health care industry is facing such an opportunity. Greater regulatory flexibility and innovations in tech-based care delivery have set the stage. There has never been a better (or more critical) time to make an all-out effort to improve health outcomes through a transition to value-based care.
Photo: Hong Li, Getty Images