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After more than a decade of experimentation, the verdict on value-based payment (VBP) models is decidedly mixed—there have been modest improvements in spending and quality but without breakthrough success in driving better health outcomes and sustainable spending at scale. Without dramatic changes in strategies, VBP risks becoming a footnote to the urgent challenges facing the United States of plateauing life expectancy, a mental health crisis, and health care spending expected to reach 20 percent of the economy by 2032.
Major reforms such as changing underlying Medicare fee structures and offering hybrid or capitated payments to primary care could accelerate adoption of VBP and improve its performance. But at this moment of social and political transition, payers and policy makers have an opportunity to also leverage patients’ frustrations with health care to wholly reengineer VBP models.
Payers and providers forgo significant opportunity to maximize the effectiveness of VBP when they do not seek input from patients on model design and implementation. Patients have rich insights into what they need for their health and well-being. They can best predict how different ways of delivering services and supports (such as in-person versus telehealth visitsor an on-site food pantry at their clinic) would fit into their lives or not. They know what health and life outcomes matter most to them. Patients’ lived experiences, perspectives, and priorities can inform many facets of value-based payment models. Taking a patientcentric approach to VBP design would raise the probability of such models achieving their aims.