The future is in value-based, patient-centric healthcare

Focusing on value-based models of healthcare is the way forward, asserts Neil Patel, President of the consulting firm Healthbox, during his talk at the recently concluded Asia Pacific Conference of the Healthcare Information and Management Systems Society (HIMSS) 2019. This, he adds, may require reassessment of priorities and disruptions of the industry.

“What kind of health system would you design if you knew you’d get paid for value?” Patel posed. “Take a look at what you have today. Would that health system that you have today look like that if it was a value-based care model? Put that at the back of your head as you plan for this brave new world… Build for tomorrow.”

In planning for this future, Patel recommended that providers keep three key assumptions in mind: patients seeking care prioritize access, convenience and affordability, that they think about themselves and their families first, and that they are ill-equipped and uninclined to think in the long-term about their own health.

While hospitals focus on delivering and maintaining the highest calibre of medical expertise, patients instead evaluate care based on the overall experience, he continued. This presents a critical disconnect in how hospitals and patients perceive value.

“Does the doctor speak the language the language that I speak? How close is this location that they have to my office or my home? Are they covered in my insurance plan? … Did I have to wait long? Did I have to fill-out redundant paperwork? Was the waiting area clean? Did they have good magazines [or] TVs with good shows on them? Was the front desk staff friendly to me?” Patel asked.

Value-based care

Healthcare systems, in turn, should be designed with this in mind. A value-based care model operates on providers having the right financial incentives, as well as the appropriate information to make decisions, taking into account costs and long-term health outcomes.

However, patients will continue to demand choice, particularly for the services and treatments that they will be paying for out-of-pocket. “They want the most bang for their buck,” Patel explains.

In order to maintain a certain standard, these new value-based models should set a floor for the quality of care, such that any choice a patient is allowed to make will generally be a good one. That is, the most basic choice should still be able to deliver an acceptable baseline quality of care, and that paying premium only expands upon this. Nothing essential is withheld based on ability to pay.

Healthcare systems should also adjust to the changing roles that physicians are expected to play. “Some would argue that the job of healthcare providers is changing now,” said Patel. “It was probably implied before that part of the job was to keep your patients well, but the incentive system didn’t pay doctors if their patients lived healthy lives based on their advice and never came back to them.”

“Now the job to be done is to help people live long and healthy lives. And a new job requires a new strategy,” he added.

Disruptors

Many companies are rising to meet this challenge. AC Health, for example, is an Ayala company and operates in Southeast Asia. Its model is ground-up, consumer centric, employing physicians that travel to patients and maximizing the convenience offered by telemedicine. Physical centres, in this scheme, are built only when and where they are absolutely needed.

ProMedica, a health system in the Midwestern United States, is also looking beyond the hospital and into the social determinants of health. Because a lot of the patients that it sees live in food deserts and have limited access to proper nutrition, Promedica established grocery stores and offered nutrient-rich foods at lower price points.

They also positioned nutritionists and chefs in these stores who helped customers make healthier choices and cook healthier meals.

“We see companies emerging to help patients and consumers do this new job. We call them the disruptors,” said Patel. “They’re providers of healthcare that are digitally enabled or out in the community. They’re building this new health system from scratch… and they bring control back to the consumer.”