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For two decades, value-based care has been built upon a simple premise: if we better manage the sickest patients, total costs of care will fall. This idea catalyzed countless disease-management programs, care-coordination models, and technology innovations. And yet, as the field has matured, an inconvenient reality has emerged. Much of value-based care isn’t truly aimed at the sickest patients.
Instead, the biggest advances have focused on high-volume, moderately expensive chronic diseases: congestive heart failure, diabetes, and chronic obstructive pulmonary disease to name a few. The formula has been straightforward — layer relatively uniform interventions (“peanut-butter care management”) across thousands of patients to achieve incremental improvement.
This is not wrong. It’s not bad. It is simply incomplete.