The German literary giant Goethe famously said, “Every day we should hear at least one little song, read one good poem, see one exquisite picture and, if possible, speak a few sensible words.” Few words in our national discussion about healthcare are more sensible than these: We can improve much by moving from today’s fee-for-service (FFS) approach to value-based healthcare.
Value-based healthcare defined
The United States spends almost 18 percent of the country’s gross domestic product on healthcare, far more than do other industrialized, developed nations. The FFS payment model in healthcare drives this high cost by encouraging and rewarding the volume of medical services, regardless of questionable efficacy, necessity or appropriateness. FFS drives volume by basing payments on quantity, not quality.
Value-based healthcare pays for quality rather than quantity. Through insurance plan designs, provider payment models and plan member incentives, this approach encourages value by rewarding better patient outcomes and warranted medical services.
Value-based surgery benefits
Over the years, the results of value-based healthcare initiatives have been uneven. But the best such initiatives have improved both the cost and quality of care delivery. One sterling example is value-based surgery benefits.
Four years of data show that bundled pricing for scheduled surgeries at centers of excellence brings dramatic cost and quality improvements to employers and employees alike. Self-funded plan sponsors typically save 20-40 percent when employees schedule surgeries through the value-based surgery solution instead of through the employers’ PPO health plans. After monthly access fees and employee incentives, employers enjoy a positive ROI averaging 4:1. Just as importantly, workers benefit from the highest-quality care and better outcomes.
1. Sanicola, Lenny, "What Is Value-Based Care?" http://www.huffingtonpost.com, Feb. 2, 2017.
2. "BridgeHealth's Bundle-Priced Benefits Save Employers 20-40% on Surgery Costs," Business Wire, http://www.businesswire.com/news/home/20170501005952/en/BridgeHealth%E2%80%99s-Bundle-Priced-Benefits-Save-Employers-20-40-Surgery, May 1, 2017.