Value-Based Health Care Offers Answers and Questions

The sitcom created by Chris Rock, Everybody Hates Chris(link is external), which ran from 2005 until 2009, conjured laughs out of the everyday. One bit I particularly relish is when the narrator (the persona of Rock as a teenager) says that his father was like Rain Man when it came to knowing what everything costs. “That’s 49 cents of spilled milk dripping all over my table. Somebody gonna drink this milk!”

We focus this month on value-based health care, an effort to find out just what everything costs—or should cost. Experts have long thrown up their hands about variations in cost and outcomes, not only across regions of the country, but across sections of a city. Value-based care is supposed to be the treatment for excesses of volume and intensity that fee for service encourages. It has been said for years: Something must be done. Perhaps, at long last, something is.

Senior Contributing Editor Michael D. Dalzell presents an in-depth look at Medicare’s efforts in this area. BPCI Advanced, a new bundled payment program, is expected to be popular. But questions persist about target prices for episodes, risk adjustment, and use of quality data.

Questions always persist. Is real-world evidence (RWE) the answer? Not yet. Contributing Editor Thomas Reinke points out that while RWE could, in theory, measure the cost-effectiveness of medications as they move from clinical trials into clinical use, there are still credibility issues. Opponents say that RWE studies serve the interests of clients.

Then there’s always: Will doctors be willing to accept downside risk? Mai Pham, MD, of Anthem and the subject of our Q&A with Editor Peter Wehrwein, thinks it’s time. Physicians can’t stay in upside-only arrangements forever because, in part, “They’re not an entitlement.”

These are just a few examples of how we examine value-based care. Look at our table of contents for more.

And don’t spill any milk.

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