Not Value Based Care... But Care Based on Values

Value Based Care

For the past decade we have blamed Fee For Service as the culprit for expensive, poor "health care" in the US. The alternative is the new philosophy of Value Based Care where we would improve outcomes and patient satisfaction at better prices... so better value. Value Based Care would address all points of the Triple Aim-- better care for patients, better health in populations, and lower costs. Heck, Value Based Care would even fix the Quadruple Aim which added clinician satisfaction to the mix.

Health care costs are still rising. Clinicians are still overwhelmed and burning out. Patients are still not engaged but are enraged by their growing share of the health care cost burden. The pharmaceutical industry blames a labyrinth of middlemen for escalating costs. Payers complain about markets and government subsidy payments. Where is the value? Can we expect Value is still coming and everything will be sorted out once MACRA goes into place. Wanna buy a bridge?

Care Based On Values

We know that clinical factors determine 6-20% of our health yet we spend 90% of our "health care" dollars for clinical expenses (in case you didn't know read this). We know there is an epidemic of chronic diseases throughout the US and other Western countries and that 80% of those chronic diseases could be prevented with better Lifestyle decisions (in case you didn't know read this).

Human beings are more than walking bags of chemicals that need a dose of this or that to be well. We need collaborative holistic care that reflects our Values... not the Value produced by a broken "health care" system. For true healthcare, we must be more inclusive and value the whole person. We must pursue not Value Based Care but Care Based on Values… for the whole person, his/her world, for social determinants of health like employment and relationships as well as nutrition, proper exercise, mindfulness and more. That means we have to change how resources are allocated to the US "sick care" industry as well as expectations. And that is happening.

Food As Medicine

Not only are consumers like you moving to collaborative holistic Care Based on Values but many in the current sick care industry also see this. With proper nutrition many chronic diseases, like diabetes, can be brought under control. Food as Medicine is not “sexy” like a new pharmaceutical cure. However, it produces results and improves lives.

Not long ago, complications from type 2 diabetes caused Tom Shicowich to lose a toe, a month of his life in the hospital and rehab, and his savings.

But today, Tom is doing much better. He’s lost 45 pounds, and his blood pressure and blood sugar have dropped so much he may soon be able to get off his medications. He’s able to enjoy a walk with his girlfriend and climb stairs more easily.

Tom’s improvement didn’t come from a new surgical intervention or wonder drug. He credits his turnaround to the help he received as part of Geisinger’s Fresh Food Pharmacy program.

The knowledge that a better diet can improve the outcome for those with type 2 diabetes is not new. But a health system giving food to folks outside the walls of the hospital may be revolutionary and long overdue.

So far, the results have been mind-blowing. All patients in the program are seeing similar results to Tom. They have significant declines in their hemoglobin A1C levels, the blood test that shows how well blood sugar levels are controlled. That drop in A1C gives them a much better chance to avoid the complications of type 2 diabetes. They won’t go blind; they won’t have kidney disease; they won’t lose a toe or a foot.

(Food as Medicine Pays Off in Pennsylvania)

What Consumers Value

Something as simple as getting real food to a fellow human being improves health. What would it look like if we asked consumers what they needed in their health? Luckily, that report just came out (sometimes I get so lucky!):

Consumers know they need financial stability and positive relationships. Some even understand the need for better eating and sleep. How many clinics offer financial planning (other than to pay them) or relationship advice? What CPT code would they use? This is the nub of the problem... our sick care system was built to care for those with infectious diseases and injuries from trauma (and they do so quite well). We need a new healthcare system that provides collaborative holistic care. Consumers need Care Based on their Values... not Value Based Care.

What Does This Mean?

If you have ever been in a casino you may have noticed that one of the first things they do at a gambling table is remove the currency and replace it with chips. It is no longer your hard-earned dollars but just some fun chips. In the US we have convinced ourselves that anything "health care" related should be covered by the exact same expenditure categories that we used to measure health care costs in 1960 (really, take a look here for more on this).

So in a sick care system items like prescriptions, durable medical goods, physician services, hospital stays and so on are covered or partially covered for those with "health care" insurance. However, those same people are not likely to get services for financial planning, employment coaching, relationship advice, massage therapy, acupuncture, better nutrition (not just counseling but actual food), etc. Those are not "health care" so consumers must purchase these with real dollars... not "health care" chips even though consumers and employers bought those chips. The "sick care" system pays for sickness... not wellness and prevention.

Consumers Want Care Based on Values

Luckily, consumers are smart people and are already bringing together their own holistic care teams that reflect their Values. For example, someone might have a primary care physician and an endocrinologist. However, that person may also have a nutritionist, an acupuncturist, a yoga instructor, a social group for exercise and a psychologist. There is a care team and the consumer selected them all.

Just look at a very few of the trends in healthcare and note the evolving payment, away from our "health care" chips:

Direct Primary Care: an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee. No fee-for-service payments. No third party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider. Patients have extraordinary access to a physician of their choice, often for as little as $70 per month, and physicians are accountable first and foremost their patients. (https://www.dpcare.org/)

No networks to herd patients to providers chosen by payers. Consumers decide and providers engage.

Health Savings Accounts (HSAs): These allow consumers to move pre-tax money into an account from which they may purchase qualified healthcare services and items. Whatever money consumers do not spend gets to grow as an investment plan.

Because these plans are designed specifically to empower consumers, many include decision-support tools designed to help their members make more informed health care decisions. In addition to health and wellness resources, most responding plans provide the following information to allow members to make informed decisions....

(https://www.ahip.org/health-savings-accounts-continue-to-grow-in-popularity/)

Consumers and Digital Health. There has been an increase in consumer use of digital technologies to help with health. This ranges from the "quantified self" where consumers capture daily readings with wearable technology to social media posts and actual meetups (like November Project). Consumer are firmly inserting themselves into their health decisions.

Complementary Medicine, Integrative Medicine, Lifestyle Medicine, Functional Medicine: If I had to put an umbrella over all these and more.. I would call it Holistic Medicine. Many physicians have opened their arms (and eyes) to other modalities and impacts on health. Consumers are responding with more bookings. Cleveland Clinic's Center for Functional Medicine has expanded twice since it was established in 2014.

Summary

Value Based Care has not worked and will not work. It simply extends the current "sick care" model and Fee For Service payment system that divorces American consumers from their "health care" dollars.

Consumers want Care Based on Values... their Values. They want their healthcare dollars to improve health, prevent illness as much as possible and have a positive, productive Lifestyle. Consumers are using Direct Primary Care, Health Savings Plans, Digital Health, Holistic Medicine and more as vehicles to better health.

Be Well!

-Tim

Tim Perry, MPA, MS, CPHIMS, PCMH CCE, CISSP is the Chief Information Officer of Consumer Health platform HealthCareToo.com. Tim has a deep passion for transforming and improving healthcare that spans two decades. He is blessed with a wonderful wife and two inspiring children. Tim has practiced Tai Chi (Taiji Chuan) for over 15 years and enjoys cooking wholesome (and easy) meals.

Other Articles by Tim

Will We Always Wait Until It's Too Late?

What If We Treated The Whole Person?

Why Patient Engagement Is So Hard: and why it won't change anything

Healthcare Is A Team Sport-- an IT Perspective

A Quick History of the US Healthcare System: How Not To Repeat It (written w/ Microsoft Sway)

Clinical Care ≠ Healthcare

Can You Handle the Truth about Healthcare?

Bending the Healthcare Cost Curve

The Future of Healthcare Is In The Past

When Will The Healthcare Dam Burst?