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Welcome to the first episode of the Healthcare Beans podcast!
Many health systems and doctors get paid regardless of your health outcomes, and that needs to change.
In this episode, I touch on the basics of how our healthcare is delivered, and how that’s changing into something better (we hope!).
See these links for accountable care organizations and bundled payment models, which are two primary ways value based healthcare is being implemented in the United States.
~ James
Transcript
Hello everyone and welcome to the Healthcare Beans Podcast, where we discuss all things healthcare. I’m your host James Haven. And today, I want to pose a question about our experiences as a patient, or as a consumer, of our health systems. At some point in our lives, we all run into health problems, and at that time we realize how we always pay for healthcare regardless of the outcome. There are no refunds if we don’t get better; we simply stay sick and end up with less money in our pocket. Do we ever stop to think of whether that’s right, and if that is the only way to operate our health systems in the United States?
So, I want to talk about a different way to operate our health systems, and it’s called value-based healthcare. In the United States, it is painfully obvious that healthcare is way too expensive, it is not well distributed across different people and zip codes, and our health outcomes are simply not good enough to justify the price tag. But there are a lot of people working hard to fix our nation’s health systems, and this is where value-based healthcare comes into play. Our entire healthcare system is undergoing a gradual deconstruction, from a system built around service fees, to a system that prioritizes value. Now, a good starting point for explaining anything about our complex health systems, is to talk about the patient experience, so I’m going to start by sharing a personal healthcare story with you.
About 2 years ago, my stomach started giving me trouble, I could not eat anything comfortably. I went to my primary care doctor – he could not figure out what was wrong with me. I then went to a GI doctor, he performed a lots of tests, and still could not figure out what was wrong. So I had an endoscopy and there was this weird encounter with some greedy anesthesiologist, who demanded to know about his payment while I was in a medical gown, lying on a gurney, moments before the procedure.
And that’s the key problem with healthcare – the health system gets paid regardless of my health outcomes.
Now fee-for-service means a healthcare provider, someone like a doctor or a group of doctors or a hospital or a clinic, some type of provider, gets paid after performing a particular type of service for you. Maybe it’s a diagnostic exam, or administering a vaccine, or heart surgery or delivering your newborn – the point is that every service, big or small, has a fee associated with it. And many experts in health policy believe that this is the core reason, or at least one of the core reasons, why healthcare spending is skyrocketing. Over time, doctors are doing more and more services, they’re getting paid more, regardless of whether you get healthy.
Under value-based care, the healthcare providers are financially incentivized to keep us healthy.
And this is achieved through risk-sharing contracts. There are lots of technical details around risk-sharing, but here’s the main takeaway; if my local health system does not appropriately manage my illness, then I’m going to see other doctors, maybe end up in the emergency room, or even hospitalized if unlucky. And under value-based healthcare, my health system will incur a financial penalty for that. So when you think about it, it’s really a fantastic, sort of natural concept that makes us wonder why we haven’t been using value-based care all this time.
So what does this mean for you, your family, your loved one.
There are good health systems and not-so-good health systems. But under value-based healthcare, bad health systems will struggle to turn a profit.
And as for good doctors, through value-based care they are getting laser focused on things that really improve your health outcomes, like care coordination, which is communicating effectively with other doctors and healthcare providers who are involved in your treatment or recovery. And they are not interested in putting you through lots of unnecessary appointments, unnecessary testing or unnecessary travel.
And they’re also giving a lot more attention to your social circumstances and how those circumstances impacts your health – do you have transportation to make your medical appointments, do you have stable housing, do you have a decent supermarket nearby where you can go and get fresh food? So these are the types of things doctors are paying attention to now, and good doctors and good health systems are building programs to address these social needs for their patients.
So when it comes to health systems in the United States, there’s plenty to complain about. But we’ve got solid reasons to be optimistic about the quality of healthcare in this country, going forward. And we’re going to touch on those reasons as we progress through this podcast series.
So that’s it for today. Please visit my website www.healthcarebeans.com to check out the topics that I write about, some of which will flow over into this podcast. Thanks again for listening to episode #1 of the healthcare beans podcast. I’m your host, James Haven. God bless
