Value-Based Care Yada Yada Yada

We know that the transition to value-based care (VBC) payment models from traditional fee-for-service models has been a big yawn of late. I wrote about the most recent sorry statistics in “Catching Up on Alternative Payment Models.” No one really seems to care as they unveil yet another huge merger or acquisition or multibillion-dollar campus expansion plan.

I care just enough to feel guilty if I didn’t read all the way through a new study published in the American Journal of Managed Care on hospital strategies to reduce costs and improve quality. Improving outcomes for less money is the definition of value.

The study is based on a survey of 203 hospitals conducted by a team of health services researchers at the Washington University School of Medicine in St. Louis. The researchers wanted to know what percentage of the hospitals implemented 20 different care redesign strategies to drive value. The strategies fell into four domains: inpatient care, outpatient care, post-acute care and care for vulnerable populations.

The “what we did” results were interesting but not nearly as interesting as the “why we didn’t” results. The researchers also asked the hospitals why they didn’t pursue care redesign strategies in the domains.

If you want to know why the VBC trend line is flat, here’s what the hospitals said.

• 73.5% said they didn’t pursue care redesign for vulnerable populations with the leading excuses being “difficulty related to patients’ lack of social support” (93.6%) and “inadequate availability of mental/behavioral health services” (89.3%).
• 64.2% said they didn’t pursue care redesign for outpatient care with the leading excuses being “patients’ inability to follow treatment or lifestyle recommendations” (88.2%) and “inadequate ability to follow up with patients for logistical reasons such as transportation, distance” (63.2%).
• 56.9% said they didn’t purse care redesign for inpatient care with the leading excuses being “competing interests, including other payment models and other quality improvement efforts” (67.4%) and “lack of personnel to support care innovations” (61.6%).
• 50.3% said they didn’t pursue care redesign for post-acute care with the leading excuses being “lack of ability to control clinical care and decision making the post-acute care setting” (73.4%) and “lack of ability to effectively follow patients after their post-acute care stay” (68.0%).

The one that stuck out to me was “competing interests.” What interests are more important than value? Than making care cheaper and better for patients? There’s your problem.

Thanks for reading.