Claims of Outcomes Improvements By So-called Value Based Designs Are Likely About Improved Access to Care

It is very common to see bandwagons that influence health policy design. Bandwagons sold digitalization during the bailout. Bandwagons shaped the managed care assumptions on the way to Obamacare. The value based bandwagon is one of the most prevalent. It is hard to contest a great intention of better outcomes with lower costs. But we should not give credit for better outcomes to value based when these improvements are about something else.

• Ask yourself, how can outcomes be improved when they are mostly determined by non-clinical factors?
• In studies that demonstrate improved health outcomes, could it be that the practices focused on a particular intervention such as value based care actually delivered care for better populations with inherently better outcomes?

There are many claims of improved outcomes via value based care. Actual documentation is sparse. When there are claims of improved outcomes, it is important to see if the actual factor improving outcomes was improved access to care. This article was stimulated by Chen-Med - a very popular source of postings on LinkedIn.

Chen-Med has done well and appears to have some claim to improved outcomes involving the vulnerable elderly.

• But is this about better value as in outcomes versus costs?
• Is this about better access to care as people with limited or no access were embraced by the Chen-Med model with major improvements in access making a difference?
• Does it help to claim that value based is the improvement, when the actual improvement was about moving populations to better access?

There Are Other Examples Where Technology or Something other than Improved Access Got Credit

Telehealth bandwagons have had a great run. There were studies that demonstrated improved costs and outcomes - but was it telehealth technology or the fact that telehealth extended health access to the homebound elderly, hospice patients, or others that had no or limited access.

Hospice patients received coordination of their care as set up by CalPERS, Sutter, and Anthem Blue Cross. Again, were the improvements in costs and outcomes about improvements in access for those with limited access?

Michigan BCBS decided to invest in the Primary Care Medical Home. Primary Care Medical Home promoters claim that their PCMH model improved the outcomes. Was it the reorganization and consultation that made the difference or was it more and better team members able to increase access - via a better financial design.

These areas are particularly important to understand as the US financial design for primary care relegates primary care where most needed to a lesser financial design and fewer and lesser team members.

As a final reminder, ask yourself this question

Is it possible for value based care to exist without the workforce to do the care and caring?

Why not focus on access at least as much as we focus on value?

Value Based Care – no progress since 1997 https://thehealthcareblog.com/blog/2020/10/12/value-based-care-no-progress-since-1997/

Many value-based payment programs may thus penalize clinicians for social factors outside their control and inadvertently transfer resources from those caring for less affluent patients to those caring for more affluent patients—the so-called reverse Robin Hood effect.26

https://jamanetwork.com/journals/jama/fullarticle/2770410

Data Science Has Become About Lending False Credibility To Decisions We've Already Made

Data designers appear to want more and more, but must understand the population to be relevant. This is particularly true in a divided nation such as the US with fewer doing well and most doing less well - and getting worse. They must consider that their data focus is making the situations worse for these Americans. https://www.dhirubhai.net/pulse/reasons-why-future-patient-data-poor-fit-us-health-care-robert-bowman/?

As we examine compromises, intolerance, and abuses including those of political and economic leaders - don't forget about the healthcare designs and designers that have long contributed to discrimination. https://www.dhirubhai.net/pulse/health-care-designs-designers-compromise-most-americans-robert-bowman/

Value Based Payment Problems Are Deadly to Basic Health Access

Designs that increased the costs of delivery while not increasing revenue defeat health access. Designs that cannot improve health outcomes need to be terminated, not replicated. https://www.dhirubhai.net/pulse/value-based-payment-problems-deadly-basic-health-access-robert-bowman/

Cancer and Geriatric Care Designs Fail for Most Americans

Try to start with understanding distributions:

• 45% of the complexity/need/adjusted demand/age related care requirements of the US population can be found in
• 40% of the population in 2621 counties lowest in health care workforce with
• About 25% or half enough generalists and general specialists (1 to 2 against) and
• 12 to 18% (1 to 3 against ratio) of geriatrics, oncology, psychiatry, and even less of more specialized workforce.
• 15% lower is about the norm for payments for office and basic services to the practices in these counties along with 30% lower payments to the hospitals in these counties for the same service

Should we focus on integration and coordination when the workforce and social supports to integrate and coordinate are largely missing?

https://www.dhirubhai.net/pulse/cancer-geriatric-care-designs-fail-most-americans-robert-bowman/

Micromanagement Fails Most Americans at the Micro and Macro Levels Their designs have consequences and complications. If you think about it you can even predict who would suffer the most - the ones already valued least, understood the least, and most abused already.

The following is a summary of the failure of micromanagement involving 2621 counties lowest in health care workforce that are already supported the least by design just as they are abused the most by the new designs.

https://www.dhirubhai.net/pulse/micromanagement-fails-most-americans-micro-macro-levels-robert-bowman/