Value-based payment - What are we overlooking?
Yes, value-based payment for healthcare has the potential to increase the quality of healthcare for those experiencing health disparities (including low income, education, race, ethnicity, neighborhood deprivation, and more). However, are we looking at the full picture of how this financing model may impact our healthcare delivery system?
Value-based payment can increase the quality of healthcare for those with socioeconomic disadvantages, by tying payment to health outcomes instead of solely to the delivery of services. However, as this recent Health Equity article notes, the emphasis on social risk factors appears to have “reduced the focus on race and ethnicity as a risk factor for disparities in health and healthcare." The authors suggest further exploration of the independent contribution of minority group status – in particular, increasing focus on four concepts (minority stress, resilience, epigenetics, and life course) that may help explain the contribution of minority group status and its association with health disparities. I recommend the article, which clearly describes each concept and its connection to health and wellness.
Another risk (not elaborated on in the article) is that the very healthcare organizations that currently serve populations with minority group status are already struggling to survive and often poorly equipped to make the structural changes necessary to engage in value-based payment. At a minimum, the model requires measuring, reporting on, and adjusting payments based on health outcomes. These complex activities can be tackled by large and financially stable healthcare organizations that can invest in new IT systems, re-training, and new roles. However, these systems changes are challenging for smaller or poorly funded organizations to undertake. My own experience implementing alternative financing models within a healthy and robust behavioral health organization suggests the implementation challenges cannot be overlooked.
If current organizations that serve the under-served are unable to adapt to the new marketplace the impact would be vast and heartbreaking. These organizations have often developed creative and culturally sensitive strategies tailored to the populations they serve – individuals impacted by trauma, severe mental illness, poverty, substance use, homelessness, and isolation. However, while they haven’t had the resources to document these service delivery models or measure their value. Will their wisdom and compassion be lost as larger provider organizations and health plans gobble up the market? Or will we seize the opportunity to invest in, learn from, grow, and sustain the providers that have traditionally served those experiencing health disparities?
