OK, I’ll admit I’ve imbibed a lot of healthcare Kool-Aid over the last four decades or so. I remember the first time I heard about Medicare implementing a prospective payment system in 1984. In my naïve mind, I thought, “Great solution. Problem solved.” Well no, PPS didn’t solve nearly enough. 

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I have had similar belief in the tenets of value-based care in the last decade. The potential to align incentives, involve patients in their care, improve quality, restrain costs...what could go wrong? Who wouldn’t jump at the chance to get on board? 

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There’s a lot of work ahead to get care management and value popular. Providers have been tussling with both fee-for-service and value-based care reimbursement for a while, and they see them as two conflicting philosophies. With FFS ingrained for decades, it will be hard to pull the plug and make the transition to VBC. 

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And consumers have baggage from their past experiences with “managed care” that run counter to desires to retain unrestricted choice in healthcare. My horror story with HMOs is when our middle daughter was born at 11:30 pm on September 30...and the hospital staff informed us that our HMO would only cover an overnight stay for my wife and the baby, meaning we would have to be out before midnight October 1. So we brought home a 20-hour old baby with no provisions for home care or support.

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We’re older now and in a Medicare Advantage plan. We get good follow up from the plan, including annual home health visits, annual checkups with our PCP, vision and dental care coverage and a stipend for healthcare supplies. More than that, there’s a sense that we’re a part of the team and everyone is rowing in the same direction. Both providers and consumers will need to believe that this new era of care will lead to higher quality and not just cost containment. 

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• Fred Bazzoli, Editor in Chief

As you dive into this COVERstory, we hope you find it becomes a reference helping you: 

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• 1. Understand current regulatory and economic forces that are accelerating the shift to value-based care. 
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• 2. Learn how leading healthcare organizations are taking steps to incorporate more value-based care into their strategies.
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• 3. Appreciate the need for partnerships and collaborations with technology partners to provide new data capabilities crucial to success in value-based care. 
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• 4. Make the successful transition from fee-for-service mentalities to a value-based care vision. 
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Read more:

• • Why quality measures are a crucial on-ramp to VBC, Moliehi Weitnauer
• • Minding gaps in revenue cycle technology to support value-based care, Jeff Becker

Read more:

• • Improving provider-payer interoperability to drive meaningful collaboration, Eric Kijak
• • Payers need more data to optimize patient outcomes under VBC, Mayur Yermaneni
• • Anderson Healthcare puts the emphasis on proactive care, Mike Ward