So Why Is Value-Based Care Not More Widely Embraced? If It Were Easy, Everyone Would Do It

Value-based care (VBC) works on paper. And value-based care has been proven to work in practice too. So why isn’t the concept more universally embraced? Why aren’t more payers, providers, and employers on board?

Simply put, if it were easy, it would be prevalent across the U.S. healthcare system. It is after all a common-sense concept: Under value-based care, healthcare providers are paid based on patient outcomes, not the number of services provided. Unlike the far-more-prevalent fee-for-service reimbursement model, VBC is focused on the value of patient care delivered, not volume.

While most agree with VBC in theory, in practice it’s been slow to take off. Truth is, implementing value-based care is complex, and sticking with the status quo is easy.

To achieve the benefits of VBC involves a daunting to-do list:

  • Establish quality metrics and standards. The ability to measure performance over time makes it necessary to establish benchmarks, achieve pre-set goals, and drive continuous improvement.
  • Put major infrastructure shifts in place. Care delivery processes need to change. Workflows need to be redesigned to better coordinate care. And the right technology needs to be put in place. While these are time-consuming, expensive propositions—they’re imperative.
  • Implement technology based on redefined processes to enable advanced data collection, analysis and sharing. Right now, healthcare data is fragmented across provider organizations, making it hard to pull together information needed to make care decisions. Interoperability hurdles and privacy/securing concerns are also in play.
  • Overcome perceptions of risk. Providers, payers, and other parties are concerned about taking on responsibility for outcomes because of factors outside their control. For example, care provided to their patients by providers outside their system, and patients’ social determinants of health may be perceived as too risky. Documenting evidence to the contrary is key.
  • Change existing regulations and policies to enable VBC. Policymakers and government agencies can provide pathways that allow private and public organizations to pilot and scale the value-based care programs that have the potential to benefit all.

Implementing value-based care is a complex undertaking with real-world obstacles that are tough to break down. But despite a slow start fraught with challenges, value-based care is a goal worth pursuing, and real progress is being made.

Enlace Health is breaking barriers that have held our healthcare system back for years. Its payer clients are experiencing real benefits of value-based care. Working closely with providers and patients, our organization is proving it’s possible to participate together in a quality-driven and economically sound environment.


This article is one in a series that advocates the need to bring specialty care under value-based care payment models. Click here to read the next article, Fixing the U.S. Healthcare System: Government Needs to Push the Private Sector.


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Doctors Feel Excluded from Health Care Value Efforts

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