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Challenges In Value-Based Care

by Denis Cortese, John Toussaint, David Krueger, and Robert Smoldt

Health Affairs

Article excerpt

Paying For Value: Perspective From The Front Lines

We propose that in a true pay-for-value system, a national payment rate should be established and rooted in reality (e.g., based on the costs of the top performing health care delivery organizations) and adjusted for three factors: a) risk of the patient population, b) geographic variation in the cost of doing business, c) patient outcomes.

Our take

Challenges in Value-Based Care

Value-based care is a mandate in U.S. healthcare, but providers are moving slowly in this direction. The issue is complex, but reimbursement remains the primary area of focus. Could global-based payment systems provide a model that all could live with?

Denis Cortese and Robert Smoldt, with Mayo Clinic; and John Toussaint and David Krueger, with ThedaCare in Appleton, Wisconsin, are proposing a national payment rate based on actual costs of delivering care and adjusted to reflect patient population, geography and outcomes. Their recommendations, on the surface, appear sound, but the comments their post has received suggests that reaching consensus on the right model to follow could be challenging.