Value Based Care - Healthcare Reform without Single Payer or the ACA

[whell]

Value-base care (VBC) holds great promise for transforming the health-care system. Through payment reform and enhanced care coordination, VBC aims to deliver lower cost, improved quality and a better patient experience. Like all new solutions, this will not happen overnight. It is likely that local results will be highly variable as health-care providers experiment with different approaches to care transformation. Employers should talk with their current health plan provider to understand what their employees are experiencing today and what future options exist to fully leverage the VBC opportunity.

https://www.mercer.com/content/dam/m...hBPT0ifQ%3D%3D

I've referred to VBC models previously in posts regarding health care reform. Here's a document that explains it pretty well in non-wonk language. The challenges to the viability of the VBC model:

- single payer, as exemplified by both the failed Colorado and failing CA single payer legislation. These approaches - similar to the ACA - preserved everything that's wrong with the payment incentives and outcomes in our current health system.

- "Medicine on demand" - meaning access to whatever "brick and mortar based" care the consumer wants whenever the consumer wants it. The emergence of "telemedicine" should help with this, but state legislation and changes to medical licensing requirements are somewhat slow to change in response to this new model of health care delivery.

We don't need a "big government" solution to the cost, access and quality issues in our health system. We need more VBC.

[icenine]

A lot of disabled adults and children rely on Medicaid, as do 75 percent of nursing home recipients. Long term health care is so expensive even Tricare does not cover it for military retirees. Whatever this VBC model is might work well for stuff your family doctor could do in his or her office. It would never replace the destruction Mitch McConnell was planning for things that are critical to everyone in American society.

[Dondilion]

Originally Posted by icenine

A lot of disabled adults and children rely on Medicaid, as do 75 percent of nursing home recipients. Long term health care is so expensive even Tricare does not cover it for military retirees. Whatever this VBC model is might work well for stuff your family doctor could do in his or her office. It would never replace the destruction Mitch McConnell was planning for things that are critical to everyone in American society.

A substantive statement.

Long term health care is really, really expensive.

[whell]

Originally Posted by icenine

A lot of disabled adults and children rely on Medicaid, as do 75 percent of nursing home recipients. Long term health care is so expensive even Tricare does not cover it for military retirees. Whatever this VBC model is might work well for stuff your family doctor could do in his or her office. It would never replace the destruction Mitch McConnell was planning for things that are critical to everyone in American society.

That's for confirming that you didn't bother educating yourself using the link provided before you criticized the subject matter.

[icenine]

Originally Posted by whell

That's for confirming that you didn't bother educating yourself using the link provided before you criticized the subject matter.

You and me won't be here forever Whell. An America with a decent safety net should be a goal for our children, bullshit right-wing "solutions" that you defer to not-withstanding.


Your link says that 61% of all back surgeries are unnecessary. Tell that to the millions who suffer from really bad chronic back pain.


I would want my daughter left behind in a world with an improved Obamacare system than whatever that it is that McConnell is planning to destroy in his seventieth decade on the planet. I guess he wants to get paid by his donors so can live it up in his 80s.

[sheltiedave]

Originally Posted by whell

Value-base care (VBC) holds great promise for transforming the health-care system. Through payment reform and enhanced care coordination, VBC aims to deliver lower cost, improved quality and a better patient experience. Like all new solutions, this will not happen overnight. It is likely that local results will be highly variable as health-care providers experiment with different approaches to care transformation. Employers should talk with their current health plan provider to understand what their employees are experiencing today and what future options exist to fully leverage the VBC opportunity.

https://www.mercer.com/content/dam/m...hBPT0ifQ%3D%3D

I've referred to VBC models previously in posts regarding health care reform. Here's a document that explains it pretty well in non-wonk language. The challenges to the viability of the VBC model:

- single payer, as exemplified by both the failed Colorado and failing CA single payer legislation. These approaches - similar to the ACA - preserved everything that's wrong with the payment incentives and outcomes in our current health system.

- "Medicine on demand" - meaning access to whatever "brick and mortar based" care the consumer wants whenever the consumer wants it. The emergence of "telemedicine" should help with this, but state legislation and changes to medical licensing requirements are somewhat slow to change in response to this new model of health care delivery.

We don't need a "big government" solution to the cost, access and quality issues in our health system. We need more VBC.

It is funny to watch you play Twister when you talk about the medical field, because you know nothing about 90% of the brochure clips you quote.

VBC is all about fining hospitals whose care metrics fall beneath a median threshold, while providing a higher reimbursement rate to those who stay ahead of the curve. This is almost entirely within the field of nursing informatics, and is meant to drive, evolve, and improve patient outcomes, not to put hospitals out of business as VBC will promote.

You deliberately chose to ignore my post yesterday re informatics and improving patient outcomes due to ACA yesterday, and then come back today to use the back end of informatics to financially reward hospitals that are ahead of median metrics, without supporting hospitals, or understanding root causes, of their lower metrics.

You truly don't even see how Gatling gun approaches fail.

[donquixote99]

Originally Posted by whell

We don't need a "big government" solution to the cost, access and quality issues in our health system. We need more VBC.

How do you get it without 'big somebody' mandating it?

Here's an interesting article, gets into the reality of what really doing VBC takes, the challenges, and what it can deliver: https://hbr.org/2017/06/value-based-...tient-outcomes

This pilot program was created with a grant, in response to ACA mandates. Big government, no?

[sheltiedave]

Whell, the patient outcomes model generally is derived from per 100,000 figures, which means everything pivots off of huge demographic modeling, which means big government. Private doctors' groups cannot afford to pay telehealth nurses, wound nurses, informatics nurses that drive these programs. Likewise, tremendous amounts of money are involved in creating paperless records and proper coding and software programs so that the informatics nurses can dive into years of records to pull out a certain niche of information, and then block out differing standards of protocol to determine which standard has proven to be most effective.

The The very essence of VBC is big government.

[whell]

Originally Posted by icenine

You and me won't be here forever Whell. An America with a decent safety net should be a goal for our children, bullshit right-wing "solutions" that you defer to not-withstanding.


Your link says that 61% of all back surgeries are unnecessary. Tell that to the millions who suffer from really bad chronic back pain.


I would want my daughter left behind in a world with an improved Obamacare system than whatever that it is that McConnell is planning to destroy in his seventieth decade on the planet. I guess he wants to get paid by his donors so can live it up in his 80s.

....well, kudos for at least skimming the info in the link, even if you pulled the above reference completely out of context.

[whell]

Originally Posted by sheltiedave

Whell, the patient outcomes model generally is derived from per 100,000 figures, which means everything pivots off of huge demographic modeling, which means big government. Private doctors' groups cannot afford to pay telehealth nurses, wound nurses, informatics nurses that drive these programs. Likewise, tremendous amounts of money are involved in creating paperless records and proper coding and software programs so that the informatics nurses can dive into years of records to pull out a certain niche of information, and then block out differing standards of protocol to determine which standard has proven to be most effective.

The The very essence of VBC is big government.

No, your premise is not correct. The large payers - insurers - are starting to push the VBC model. Most of the major health insurers offer some form of the VBC model, and are continuing to extend access to that model across their insured base.

That's not to say that "big government payers" could also transition to a VBC model. Medicare and Medicaid are still fee for service models, and those on the left who clamor for "Medicare for all" are simply asking for an entrenchment of the issues that are brought about by fee for service.