VBC Doesn’t Happen Overnight. But It’s Happening Now.

The journey toward value-based care isn’t easy. No one says otherwise. But the VBC promise is so compelling, so right, that an influential contingent of providers, payers, patients, and policymakers are doing what it takes to replace our broken fee-for-service healthcare payment model once and for all.

These forerunners have a vision that’s catching on fast. They’re taking the stance that healthcare must be restructured from the inside out–and it takes alignment of all parties involved. While they’re the first to maintain that there are no quick fixes, they’re making measurable results happen now. An increasing number of healthcare leaders are proving it’s possible to transform a chaotic, inefficient healthcare system into one built on connectivity and logic that benefits everyone.

BCBSNC VBC Program: $500M Savings, 5% Decrease in Unplanned Admissions

Take Blue Cross and Blue Shield of North Carolina. This progressive payer (and Enlace Health client) has value-based arrangements with 12 major health systems and 800 primary care practices. Its VBC program serves more than 1.4 million members.

In the last three years, members have saved $500 million, experienced a five percent decrease in unplanned admissions—and are achieving success around patients taking positive steps to manage their health.

This is just one example of how a costly, volume-centric fee-for-service payment structure is being replaced with a value-based approach that contains costs and boosts quality.

The BCBSNC case is just one that proves that VBC works. VBC is happening now—and the good news is more progress is being made—and measured—over time.

Value-Based Payment Models Challenged by FFS Dynamics

An article in Health Affairs written by Hoangmai H. Pham and Amol S. Navathe contends that barriers to successful value-based payment models are difficult to overcome. The authors maintain that FFS dynamics already in place make it hard to achieve the potential of VBC.

Currently, the U.S. ranks 11th for healthcare outcomes. A huge percentage (19.7%) of our annual GDP goes toward healthcare. What do these numbers reflect? Our country’s continued dependence on a broken payment model doesn’t serve our people well.

Navigating VBC Barriers: Realizing Potential Together

The article’s authors have a firm grasp on the challenges ahead, and both have a clear vision of what it will take to realize VBC’s full potential in the near future:

• The importance of the Centers for Medicare and Medicaid Services (CMS) and legislators in achieving incremental wins in the move from FFS payments to VBC payments to continue to prove the concept.
• They advocate bold steps to encourage competitive terms in commercial contracts.
• The authors emphasize healthcare equity as motivation for all parties to continue to invest in care improvement measures.

The healthcare system today will improve (or not) as a whole. To achieve the beneficial dynamics our system needs requires all parties across public and private sectors to pull together as one.

Enlace Health is proof positive that VBC barriers can be overcome—and that obstacles standing in the way can be navigated successfully.

References

Why Aren’t Value-Based Payment Models More Successful? A Failure To Confront Market Dynamics

BCBS North Carolina’s value-based care model has saved members nearly $500M in 3 years