How Should Health Systems Discuss Value-Based Care with Patients?

How should health systems and insurers talk to policymakers, patients and plan members about the concept of value-based care? That was one of the questions addressed by a recent panel discussion hosted by the Duke Margolis Institute of Health Policy.

Kevin Larsen, M.D., senior vice president of clinical innovation at Optum, and a former senior health IT advisor at HHS, said he got a lot of practice at this when he was explaining to  clinicians why the Meaningful Use program’s interoperability efforts were important. “I believe that the future is already here; it just isn't scaled,” Larsen said, "so I tend to tell a story. I tend to find a place that actually is living out what we want the future to be so people can imagine it and then point to it.”

He says he will often tell personal stories about when he’s had really good care in a value-based care organization — care that was completely coordinated, very flexible, and really centered around him. “Then I'll point out what are all the things that actually made that happen. The data was interoperable, the system was proactive, the waiting room was empty because they were so efficient, and they got me in right away. They supply my equipment right in the room, because there isn't a separate payment model to go to a separate place. Those kinds of stories tend to resonate with people, and you can often find examples all around you and hold them up. But then also says here's here's why that works, because the HIE in that state is so effective at moving data back and forth that you have a seamless data experience in your state. Those inspirations, are an easier way to get into the technical details, I find, rather than starting with a policy or a technical description.”

Natalie Davis, CEO of United States of Care, a policy organization dedicated to making our healthcare system more equitable, said her organization has done a lot of listening tours to see what would resonate with people across the country as we think about the promise of paying for and delivering healthcare differently. "For a decade, we've talked about it in terms of payments and incentives and people being placed into models and attribution and risk adjustment, and that doesn't actually resonate with people,” she said, “and it doesn't resonate with the policymakers that we need to make sure this stays a bipartisan effort."

What did resonate with people, Davis added, is the idea that they would be seen as a full person — that their elbow pain and their back pain might be connected to their diabetes and their mental health. They like the idea that they have more time with their doctor, the idea of care coordination and having people help them move through the system, and their data would move with them, that doctors would talk to each other, and they wouldn't have to be the in-between, she said. 

"People absolutely hate the word value,” Davis stressed. “It makes them think of bargain brands. One woman said she doesn't buy value brand bacon, and so she doesn't want value brand healthcare. It really turns people off. And that's not just about lipstick on a pig. It really is the idea of, can we make this people-centered and make sure that we're moving it forward? What we hear from our listening work is really clear. People want a different way for healthcare to be delivered. They really want to be at the center of it. And we know that patient-first care models are being explored.” 

Purva Rawal, former chief strategy officer for the Center for Medicare and Medicare Innovation, noted that we now have over 50% of Medicare beneficiaries in these accountable, longitudinal care relationships. "Our hope is that we're developing models and care programs where people are seen as a whole person in the way that Natalie described, and that all of their needs are being assessed and their care is being coordinated.”

That care is more people-centered has helped galvanize this accountable care movement, Rawal said. “We really want to be able to deliver whole-person care across primary and specialty settings. We want to be able to use data interoperability to assess people's health-related social needs, which we know are critical to achieve better outcomes, and then support people in navigating what's a really complex health system, and hopefully accountable care helps us do that, too.”

Rawal sees a real need and a real opportunity to focus on sustainability and simplicity. “I think those those two concepts are really related. To deliver whole-person care through these accountable care relationships requires sustainability. We need predictability. Payers need predictability and sustainable models to be able to deliver this type of care. We should continue to focus on new and simpler approaches to things like benchmarking and payment methodologies that reflect the true cost of delivering care and that over time, take into account the efficiencies that are being produced, hopefully, in these programs. And simplicity is really important to mention. If you want this type of care to be sustainable and scalable, we need things like common definitions. We talk a lot about quality measure alignment, but there's a whole other layer of alignment and simplicity as well.”

Optum’s Larsen noted that when he works with really mature value-based care systems, they have eliminated a lot of the waste in their system. “They're they're much more user friendly, they're much more integrated, they're much more connected, they're much more person-centered, so that's the future that I see.” But he stressed that interoperability is important. "If we're going to have a free market where this also works, we actually need our systems to be able to connect and the data to move back and forth, like Amazon does with all of its vendors.”