What is the Value in Value-Based Care and My Role Providing it
Since the pandemic, we have seen a growing distrust in the US healthcare system – multiple studies and polls have demonstrated these trends over the past few years.[i] [ii][iii]One would hope that recent tragic events, and the mixed response from the public, might be the wake-up call needed to amplify the drumbeat of change, and yet, I worry there will be no effect. And so, with props to one of my favorite substack writers, Dr. Benjamin Schwartz of “The Surgeon’s Record”, I want to echo his statement that “We shouldn’t allow these moments to pass with distraction instead of accountability.[iv]” It is time for us all to ask ourselves as providers and participants in a broken healthcare system, what will it take to fix a broken system? What is the “value” in value-based healthcare, and what is my role in providing it?
Most conversations define “value” in business terms: quality outcomes/the cost of delivering those outcomes. But, in practice, defining value is not easy; the specifics mean different things to different stakeholders, and measuring a “soft ROI” does not align with most business models put forth by those paying for care. If we are to get this right, we must be able to get the different definitions of value out on the table so that we can develop a shared understanding of what we are trying to achieve in “paying for value”.
What is value for a patient?
In my experience as a practicing family doctor, value for patients revolves around “whole person care” – being seen, and treated, as a person rather than a disease or procedure. A physician who follows up in a timely fashion, helps a patient understand their medical condition(s), engages them in conversation about their health goals. Someone who listens well, pays attention to the details of that patient’s life, and develops treatment plans tailored to outcomes that help them thrive. This kind of care takes time – something in short supply in healthcare – and is largely built on trust.
What is value for a health system or other provider of care?
First and foremost, most providers of healthcare want the highest quality care – defined by the National Academy of Medicine as care that is safe, effective, timely, efficient, and equitable. Achieving these outcomes is not simple. People, process, and technologies all play a role, usually in highly interdependent and fast paced environments. And, as health care organizations enlarge in size, we have only seen costs, and inefficiencies, grow. How do organizations shift from “top down” management of care to empowering front line care teams to handle the day-to-day unpredictability and still provide that high quality care?
What is value for a payer?
Another word for payer is “us” – we are all paying for healthcare. Employers and individuals purchase health insurance, supplying the revenue streams that flow through insurers to pay providers of healthcare services. Taxpayers pay for government sponsored healthcare services. Most payers want cost-efficient care that is coordinated across care sites, resulting in high quality outcomes.
Given all that, what is my role as a provider?
One doctor cannot solve this; one health system cannot solve this; one payer cannot solve this; one patient cannot solve this – however all of us trying to understand how each can contribute to the larger solution can move us closer to the goal. As a physician, I can start by asking questions – how do I prevent illness and deterioration where possible, rather than just treat it? How do I shift the focus to prevention? How do I engage my patients in their own care before they get sick? How do I help better coordinate my patients’ care? Additionally, I will need to learn to practice alongside my team – not just the team next to me in clinic, but the teams in the background that help me care for my entire patient panel. How do I identify high risk patients and connect them with resources to help them thrive? How do I use data to inform my clinical decisions? How can I optimize the use of health care resources as I keep the quality of my care high?
Ultimately, the move to “value” means we are moving into the age of “accountability”. We all know that we are spending far too much money on healthcare for the outcomes we are getting. While there are multiple forces at play here, we must do a better job of acknowledging our role in this. We want, and should expect, to be paid for giving “high value care”, but this means we will need to step in and engage in ways we have not previously – with patients, with healthcare providers, with payers, and with legislators. We can embrace this change, and help to shape it, or we, and our patients, will be shaped by it.
[i] https://www.news-medical.net/news/20240801/Study-reveals-deepening-mistrust-in-healthcare-providers-post-COVID.aspx
[ii] https://news.gallup.com/poll/508169/historically-low-faith-institutions-continues.aspx
[iii] https://www.techtarget.com/patientengagement/news/366599683/Patient-trust-in-healthcare-tanked-during-COVID-19-pandemic
[iv] https://thesurgeonsrecord.substack.com/p/2025-the-year-of-the-wood-snake-7