Value-based Care: It starts with the patient

By Dennis Hagemann
Thursday, October 19, 2017
A picture of two people

Imagine for a moment a woman with a pain in her leg. She goes to see her doctor, who orders a battery of tests. The results aren't conclusive, but the doctor hands her a bottle of pills. The medication doesn't bring any relief, so the woman returns to the doctor. He prescribes a second medication; this one doesn't work either.

Then the doctor sends the woman to a specialist. The specialist also orders a half dozen tests, some of which the woman had already undergone. The results are again inconclusive, but the surgeon recommends surgery. The woman goes under the knife. Three months later, she's still in pain.

This is not how anyone wants the healthcare system to work. It's time consuming. It's expensive. And ultimately, it's ineffective. But this is how the U.S. health care system has traditionally operated. Practitioners make more money for performing more procedures, regardless of how effective they are.

That's changing. We're slowly converting to a system that rewards practitioners for what really matters -- helping patients get, and stay, healthy. This model is referred to as "value-based care” and the focus is on the patient: what does she need? What is the most efficient and effective way to help her meet her goals? Is she satisfied with the results?

It all starts with the patient. The physician is incentivized to take the patient's perspective and look at her health deliberately.

So what does value-based care look like in practice?

  • Patients are empowered. Patients fully understand all aspects of their care, from diagnostic tests to treatments and are able to make informed choices.

  • Providers coordinate. Doctors and nurses share information, test results and insight into patients' health, allowing patients to skip redundant tests or ineffective treatments.

  • The focus is quality. Patients see improvements in quantifiable metrics, such as cholesterol levels or blood pressure. Patients report being satisfied with their care, not frustrated by ineffective treatments.

  • Employers and patients save money. Not only do employers spend less on healthcare premiums, but they benefit from having healthier, more productive employees.

Increasingly, providers are forming “accountable care organizations” to provide value-based care. These groups strongly encourage providers to coordinate all aspects of a person's care. Doctors and nurses must communicate with their colleagues to be sure that patients are receiving the care they need -- and not repeating tests or procedures that have already been performed.

It's also important to understand what value-based care is not. It's not insurance companies telling providers what to do or rationing out care.  It's not withholding service. It's not saying, 'You can only do this and not that. Doctors make those delivery decisions."

The crucial component of value-based care is quality. To analyze the quality of care, Premera looks at discrete metrics -- test results and screening levels-- but also bigger questions. Are patients getting better?  How often are patients rapidly readmitted after being released from the hospital? Do patients leave the hospital with a clear plan for follow-up care?

Over the past several years, Premera has emerged as a leader in value-based care. We really launched  a different way of doing business in 2011 by inserting measures and metrics into global outcome contracts. The company began tying reimbursements to quality and cost effectiveness. Premera then began working with two dozen hospitals to improve quality. Now the company is talking with provider groups about what is important to them -- and their patients -- and how to improve results.

While it's still early to evaluate the success of these efforts, what is clear is that all parties -- Premera, providers and patients-- recognize the benefits of coordinated and effective care.

We should certainly be guided by results, whether they're financial or quality measurements. This has to be a long-term effort and we have to take the long view.



Related Articles

Suicide Prevention Lifeline

Suicide prevention and resources for Premera customers

The public health issue of suicide is becoming alarmingly more common. Dr. Mia Wise discusses this rise in suicide rates and shares resources.

Monday, September 09, 2019

Understanding rural healthcare in Alaska

Premera’s Rural Health Initiative team has been traveling to communities in our home states, speaking with experts and community members about the issues they face.

Monday, December 10, 2018