Health leaders question how, not if, value-based care should be implemented

When it comes to value-based care, the question is no longer if it works, but how it is best implemented.

One option is through hospitals and health systems creating risk-based contracts and another is through third-party companies creating a network of independent practices that can coordinate value-based care for a population.

When looking at the first option, one example of a health system implementing value-based care is Mass General Brigham. The system contracts value-based care in the Medicare, Medicaid and commercial markets.

"We're in all three – we do risk-based contracts for all of our patients served by our primary care doctors," said Timothy Ferris, CEO of the Massachusetts General Physicians Organization during the HLTH 2020 virtual conference on Monday.

On the other side are companies such as Aledade, which has created a value-based care network for independent practices across the nation.

"[Independent physician practices] lack scale; they lack data; they lack technical capabilities. They lack the coaching and all of the structures that these health systems do have," said Farzad Mostashari, the cofounder and CEO Aledade, in the HLTH session. "But I can give them that."

When it comes to which is better, that's up to interpretation.

Ferris argues that his health system is in a better place to implement value-based care, because the institution puts pressure on physicians to do better care.

"The incentives that we place on our doctors are incentives to manage care, not to make money on more or less care," Ferris said. "Because all of our doctors are employed. That means they collect a salary, it may have some variable pay, but it is not like being in a private practice."

From Mostashari's perspective, the fact that hospitals have to worry about a reduction in hospitalizations leading to a loss in revenue puts his company's method in a better position.

Ferris said that because the Mass General health system has access to greater amounts of internal capital, it can counteract that fear.

"Yes, hospitals are losing money in certain situations where we are managing care and reducing hospitalizations," he said. "But we are using that to redeploy those capital assets in a way that generates benefit for our patients and for the system overall."

Further, Ferris said that health systems that have a mission to keep their communities healthy won't have a problem taking up value-based care.

"If you are in business to maximize revenue, then you are going to stay away from value-based contracts and you are going to minimize the extent to which you are integrating yourself with the local community to provide an integrated delivery system," Ferris said. "But if your mission is to care for patients and maximize the health benefit of the community then you're going to take a different approach."

However, at the end of the day, hospitals are businesses and businesses have to make business decisions, according to Mostashari.

"You know, Mass General is a business," Mostashari said. "It doesn't matter if it's a tax-advantaged business, it's a business. And the institutional decisions that are made, the priorities that are made, about whether we focus over here or over there are going to be driven by a Mass General as a business, not by the individual professional decisions and ethos of those individual doctors and nurses who are working there."

Whether value-based care is delivered through a health system, accountable care organization or through a group of private practices, what matters most is the fact that patients are getting the best care for their money, Bryony Winn, the chief strategy officer at Anthem and the moderator of the debate said.

"This is a material conversation," she said. "I think we've shifted past saying 'Should we do value-based care?' And now the materiality is on how. And what you got from this is that there are real choices in how to change the cost and quality trajectory of the care we deliver here."

Twitter: @HackettMallory
Email the writer: mhackett@himss.org