What is Value Based Care Anyways

For the past 7 years I have read 100's of articles, posts, research, guidelines and tweets. I have watched webinars, in-person presentations, talked to payors, billers, providers of all kinds of backgrounds and am still at a loss.

I recently read Dr. Sachin Jain's Forbes article and it left me at a loss and he is highly articulate, thoughtful and considers most every angle on VBC.

It lead me to pose this question, which I felt needed it's own post... just in case someone just happens to have some answers or at least more questions that will help my mind lead to some solutions.

... it appears to be "well known" that patients who are well managed in primary care have better health outcomes and less long term costs to the system, yet the focus (read payment) is measured by acute hospital stays, ED visits, surgeries, etc...

Is this assumption true?

What should/could be measured?

How should/could PCP - to include care managers, nurses, etc... be compensated?

I work within the primary care space that includes Peds/FP/IM/Psychiatry with MD's and lots of NP's; this is a cross over of physical and behavioral health.

Forgive me, but when I hear terms like Integrated Behavioral and Primary Care I start getting highly optimistic and feel like I need to pinch myself. Even one better, when a leading group of practitioners, experts, etc... produced the robust piece on High Quality Primary Care Guidelines with the NASEM, which called for increased funding for education for providers (because their has been an ongoing shortage) and payment reform that looks beyond short-term savings.

The data exists to show costs to the system for undx/untx ADHD for instance, costs in the thousands, both direct and indirect, increased morbidity - 3-5x increase in suicide, SUD, the list goes on and on ... yet the payment doesn't seem to cover the impact. Does this make sense?

From the NASEM Primary Care Quality Document Call to Action

Change the Standard for Evaluating and Supporting Payment Models Primary care payment models to date have largely been judged based on their ability to generate cost savings. Payment models that support integrated, interprofessional primary care teams working in sustained relationships with patients and families will ensure that high-quality primary care is possible to implement and sustain.

ACTION: Medicaid, Medicare, commercial insurers, and self-insured employers should evaluate and disseminate payment models based on the ability of those models to promote the delivery of high-quality primary care and not on their ability to achieve short-term cost savings.

I am just a laymen trying to understand and advocate for PCP and care managers for payment and parity.

I am not looking for a pot of gold at the end of the rainbow - I am just trying to see if the rainbow is real or a mirage?

Yes, I work for a medtech company that provides a tool for assisting in improving assessment and management of an area within BH/PC, but more important than that -

I am a consumer who comes from a place of privilege in that my HCP's look like me, are covered (for the most part) under my insurance and I don't have a need (yet) for mental or behavioral health benefits. That said, I am also a daughter, a wife, aunt, granddaughter, cousin, friend, and colleague who has been trying to uncover this can of worms for those who need me to because maybe they can't.

I would love to hear what providers and payers thoughts are on this, particularly those who share similar space.