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Valued-based care has become a household name in healthcare.
Philip Louie, MD, a spine surgeon at Virginia Mason Franciscan Health in Tacoma, Wash., connected with Becker’s to answer, “What is the future like for value-based care in orthopedics?”
Note: This response has been lightly edited for length and clarity.
Dr. Philip Louie: Very complicated, like peering through fog without a compass.
Value-based care, in its most basic form, is founded on a simple equation [value = quality/cost], with value being the highest priority of orthopedic care. The initial wave was full of momentum and fanfare supporting the transition from the long-standing model of fee-for services to a value-based care model, in which reimbursements would follow outcomes, rather than volume. Ultimately, this value-based care model aims to bring all the stakeholders into alignment, centering around the four important elements of access, cost, quality and the patient experience. This lies in conflict with a fee-for-service model. The conflict has always been between the health plan or payer, insurance company, or employer government agency who want to lower costs as much as possible, thus encouraging a drive toward volume to reach a reasonable financial performance.
Aside from the enormous administrative burden that these goals have presented with, we still poorly understand both parts of the equation in orthopedics.