Valued-based care has become a household name in healthcare.
Philip Louie, MD, a spine surgeon at Virginia Mason Franciscan Health in Tacoma, Wash., connected with Becker's to answer, "What is the future like for value-based care in orthopedics?"
Note: This response has been lightly edited for length and clarity.
Dr. Philip Louie: Very complicated, like peering through fog without a compass.
Value-based care, in its most basic form, is founded on a simple equation [value = quality/cost], with value being the highest priority of orthopedic care. The initial wave was full of momentum and fanfare supporting the transition from the long-standing model of fee-for services to a value-based care model, in which reimbursements would follow outcomes, rather than volume. Ultimately, this value-based care model aims to bring all the stakeholders into alignment, centering around the four important elements of access, cost, quality and the patient experience. This lies in conflict with a fee-for-service model. The conflict has always been between the health plan or payer, insurance company, or employer government agency who want to lower costs as much as possible, thus encouraging a drive toward volume to reach a reasonable financial performance.
Aside from the enormous administrative burden that these goals have presented with, we still poorly understand both parts of the equation in orthopedics.
Outcomes: Which ones are the most meaningful? How many should we obtain? Which ones are most centers collecting? Are patients tired of filling out surveys? How do we promote transparency?
Costs: How do we best calculate them? Which costs are most important? What are the main drivers? Traditional cost-accounting methods miss significant variables; can time-driven activity based costing capture the meaningful costs?
The rise of digital health tools will drive the advanced data analytics, which will help with everything from patient engagement to population health management. I still believe in the overarching goal of value-based care in which we aim to align our interests (the healthcare providers) with the health and wellness of the patients. While there are challenges in implementing this model, including the need for significant infrastructure and data capabilities, the potential benefits of ensuring that patients get the right care at the right time in a sustainable fashion keeps us pushing forward.