Looking for others who work in the value-based space (I work in administration at a health system). I have seen the following pros and cons to VBPs, and am curious what others’ experiences have been.
Pros: - Attempt to change incentives. I see recognition on both provider and insurance sides that fee-for-service is broken and needs to change. It’s refreshing to hear insurance executives say this out loud in meetings. - Meeting topics and goals shift to actual patient value, away from “productivity” measures like RVUs and towards quality measures and reducing total cost of care. - Beginning to focus on social determinants of health - housing, food access, mental/behavioral health, etc.
Cons: - VBPs are still built on top of fee-for-service, not as a replacement to it. Therefore, there are still plenty of volume-based incentive metrics like # of screenings and visits. - Not yet transformational. At my health system VBPs are only like 1-2% of total revenues, and we’re about 5-6 years in. - “Quality” is still, IMO, incorrectly defined as cancer screenings and annual wellness visits…see above on volume-based. Instead of volume of cancer screenings…how about measuring improvements in early detection rate and outcomes of your cancer treatments program(s)? - Risk-capture and coding/documentation are keys to success in all the VBPs I’ve seen. This means more clinical time at the keyboard (more fee for service activity!!). This is a heavy push from insurance, since their premiums go up if risk scores go up.
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