A value-based payment system could revolutionize health care as we know it

The health care payment system is due for a major overhaul.

Photo: Getty Images
  • Value-based health care focuses on tangible improvements in patient care outcomes.
  • The goal is to reduce the per capita cost while improving treatment.
  • Current fee-for-service payment models focus too much on quantity and not quality of care.

Throughout the century, miraculous advances in medicine and scientific breakthroughs have brought the health care profession to a new zenith of excellency. Incurable diseases have been eradicated and conditions that were once death sentences are now vanquished with a quick pill or surgical fix.

But underneath all this progress lies a vestigial sore weighing down the entire health care industry – the limited health care financial system. While medical care and technology itself has advanced to greater heights, the underlying business and financial functions are lacking.

The mounting costs of a fee-for-service health care payment model and subsequent lack of oversight on the quality of care is becoming too much to handle for both individuals and employers alike.

A recent report from the Health Care Cost Institute found that per-person out of pocket spending has reached an all time high for Americans under the age of 65 who are covered by employer-sponsored insurance.

Data gathered from that same report shows that employer coverage has risen 44% per enrollee between 2007 and 2016. The total cost of spending on employer health care services has ballooned to an annual cost of nearly $700 billion.

What's the underlying issue for this? The problem may be endemic to a fee-for-service payment model.

Time to shift to a value-based payment system

The current state of payment systems in health care takes the form of disjointed and disparate bill of costs that don't take into account whether or not the treatment was valuable. Let's look at a simple example on why this is so.

  • Fee-for-service care - A patient undergoes surgery. They end up getting an infection. On their next visit back to the medical center the patient now bears the cost to treat it.
  • Value-based care - A patient undergoes surgery. They end up getting an infection. On their next visit back to the medical center the hospital bears the cost to treat it.

While this is an overly simplified example, it cuts to the heart of the issue. Health care services and payments need to be held accountable for what value they bring and not what laundry list of treatments they doll out.

Fee-for-service models lower quality of care and are a disservice to patients and employers alike. Michael J. Dowling, president and CEO of Northwell Health, argues that the rising costs are intrinsically tied to lower quality of care. "Value-based care ties reimbursement to quality, not quantity of care. The goal is to incentivize better care and lower costs," he writes in "Health Care Reboot".

Dowling imagines a world where the quality of care is the standard rather than the volume of care.

A lot is at stake here. Business as usual is going to be unsustainable for both hospitals, employers and individuals. For institutions like Northwell Health, clinical outcomes are paramount; health care improvement and high-quality care need to become the norm.

And patients agree. In a quest to figure out just what value-based health care means to patients and physicians, The University of Utah conducted a far-reaching survey. The results showed that patients identified a few key characteristics of high-value health care:

  • Around 62% considered the quality and effectiveness of their care to be the most important factor of high-quality health care.
  • 26% were most concerned with their out-of-pocket costs.

Major companies are already taking note and are springing into action with new plans.

Employer initiatives with value-based health care plans

Are employers doing enough for their employees?

Source: 2017 Willis Towers Watson Best Practices in Health Care Employer Survey; 2017 Willis Towers Watson Global Benefits Trend Survey, United States.

For quite some time, companies tried to cut down on costs using measures like increasing employee expenses and limiting their coverage and access to certain specialists. But now they're realizing that this is not the way to go, and are instead taking a more active role in developing their value-based health plans.

Multinational insurance broker Willis Tower Watson has found that an increasing number of companies are opting to negotiate directly with health care providers to apply value-based payment systems.

According to its survey, in 2017 only 6% of employers were pursuing the aforementioned plans. Twenty-two percent of employers surveyed said they intended to start working directly with providers to change the payment system in 2019.

More promising numbers from the same survey point towards a majority 65% of companies also making this a priority over the next three years.

This rising trend has put forth a lot of new exciting initiatives. On the ground floor, better care is already being seen. One such example is from something called a patient-centered medical home, where a team of medical professionals build a personal relationship with their patient to anticipate their needs and make sure they're cared for in the best manner. This would include screenings based on the patient's age, gender and medical condition.

This approach would be most likely used for patients with high-cost chronic conditions. David Lansky, CEO of the Pacific Business Group on Health, initiated something like this in his company's Intensive Outpatient Care Program.

Lansky explained that his organization:

"...identified 15,000 people with multiple chronic conditions and severe challenges in getting good care, and helped pay for primary care teams that would deliver coordinated care, address social needs, and address mental health needs, all under a prospective payment to the care team."

More and more companies are embracing this new value-based approach. The results are reduced hospitalizations and costs. Walmart's Center of Excellence program has also been leading the charge to cut costs and improve care with an integration of the best care it can provide for its employees.

While this is just the beginning in this new trend, we're already seeing that value-based payment models are incentivizing better care for all.

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The 2020 Atlantic hurricane season got started early

It looks like a busy hurricane season ahead. Probably.

Image source: Shashank Sahay/unsplash
Surprising Science
  • Before the hurricane season even started in 2020, Arthur and Bertha had already blown through, and Cristobal may be brewing right now.
  • Weather forecasters see signs of a rough season ahead, with just a couple of reasons why maybe not.
  • Where's an El Niño when you need one?

Welcome to Hurricane Season 2020. 2020, of course, scoffs at this calendric event much as it has everything else that's normal — meteorologists have already used up the year's A and B storm names before we even got here. And while early storms don't necessarily mean a bruising season ahead, forecasters expect an active season this year. Maybe storms will blow away the murder hornets and 13-year locusts we had planned.

NOAA expects a busy season

According to NOAA's Climate Prediction Center, an agency of the National Weather Service, there's a 60% chance that we're embarking upon a season with more storms than normal. There does, however, remain a 30% it'll be normal. Better than usual? Unlikely: Just a 10% chance.

Where a normal hurricane season has an average of 12 named storms, 6 of which become hurricanes, and 3 of which are major hurricanes, the Climate Prediction Center reckons we're on track for 13- to 29 storms, 6 to 10 of which will become hurricanes, and 3 to 6 of these will be category 3, 4, or 5, packing winds of 111 mph or higher.

What has forecasters concerned are two factors in particular.

This year's El Niño ("Little Boy") looks to be more of a La Niña ("Little Girl"). The two conditions are part of what's called the El Niño-Southern Oscillation (ENSO) cycle, which describes temperature fluctuations between the ocean and atmosphere in the east-central Equatorial Pacific. With an El Niño, waters in the Pacific are unusually warm, whereas a La Niña means unusually cool waters. NOAA says that an El Niño can suppress hurricane formation in the Atlantic, and this year that mitigating effect is unlikely to be present.

Second, current conditions in the Atlantic and Caribbean suggest a fertile hurricane environment:

  • The ocean there is warmer than usual.
  • There's reduced vertical wind shear.
  • Atlantic tropical trade winds are weak.
  • There have been strong West African monsoons this year.

Here's NOAA's video laying out their forecast:

But wait.

ArsTechnica spoke to hurricane scientist Phil Klotzbach, who agrees generally with NOAA, saying, "All in all, signs are certainly pointing towards an active season." Still, he notes a couple of signals that contradict that worrying outlook.

First off, Klotzbach notes that the surest sign of a rough hurricane season is when its earliest storms form in the deep tropics south of 25°N and east of the Lesser Antilles. "When you get storm formations here prior to June 1, it's typically a harbinger of an extremely active season." Fortunately, this year's hurricanes Arthur and Bertha, as well as the maybe-imminent Cristobal, formed outside this region. So there's that.

Second, Klotzbach notes that the correlation between early storm activity and a season's number of storms and intensities, is actually slightly negative. So while statistical connections aren't strongly predictive, there's at least some reason to think these early storms may augur an easy season ahead.

Image source: NOAA

Batten down the hatches early

If 2020's taught us anything, it's how to juggle multiple crises at once, and layering an active hurricane season on top of SARS-CoV-2 — not to mention everything else — poses a special challenge. Warns Treasury Secretary Wilbur Ross, "As Americans focus their attention on a safe and healthy reopening of our country, it remains critically important that we also remember to make the necessary preparations for the upcoming hurricane season." If, as many medical experts expect, we're forced back into quarantine by additional coronavirus waves, the oceanic waves slamming against our shores will best be met by storm preparations put in place in a less last-minute fashion than usual.

Rossy adds, "Just as in years past, NOAA experts will stay ahead of developing hurricanes and tropical storms and provide the forecasts and warnings we depend on to stay safe."

Let's hope this, at least, can be counted on in this crazy year.

Facebook finally adds option to delete old posts in batches

Got any embarrassing old posts collecting dust on your profile? Facebook wants to help you delete them.

Facebook
Technology & Innovation
  • The feature is called Manage Activity, and it's currently available through mobile and Facebook Lite.
  • Manage Activity lets users sort old content by filters like date and posts involving specific people.
  • Some companies now use AI-powered background checking services that scrape social media profiles for problematic content.
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New simulations show how supermassive black holes form

Researchers from Japan add a new wrinkle to a popular theory and set the stage for the formation of monstrous black holes.

Image source: Sunmyon Chon/National Institutes Of Natural Sciences, Japan
Surprising Science
  • A new theory takes the direct-collapse theory explaining the creation of supermassive black holes around which galaxies turn ones step further.
  • The advance is made possible by a super-powerful computer, ATERUI II.
  • The new theory is the first that accounts for the likely assortment of heavy elements in early-universe gas clouds.

It seems that pretty much every galaxy we see is spinning around a supermassive black hole. When we say "supermassive," we mean BIG: Each is about 100,000 to tens of billions of times the mass of our Sun. Serving as the loci around which our galaxies twirl, they're clearly important to maintaining the universal structures we see. It would be nice to know how they form. We have a pretty good idea how normally-huge-but-not-massive black holes form, but as for the supermassive larger versions, not so much. It's a supermassive missing piece of the universe puzzle.

Now, in research published in Monthly Notices of the Astronomical Society, astrophysicists at Tohoku University in Japan reveal that they may have solved the riddle, supported by new computer simulations that show how supermassive black holes come to be.

The direct collapse theories

Glowing gas and dark dust within the Large Magellanic Cloud

Image source: ESA/Hubble and NASA

The favored theory about the birth of supermassive black holes up to now has been the "direct-collapse" theory. The theory proposes a solution to a cosmic riddle: Supermassive black holes seem to have been born a mere 690 million years after the Big Bang, not nearly long enough for the standard normal black hole genesis scenario to have played out, and on such a large scale. There are two versions of the direct-collapse theory.

One version proposes that if enough gas comes together in a supermassive gravitationally bound cloud, it can eventually collapse into a black hole, which, thanks the cosmic background-radiation-free nature of the very early universe, could then quickly pull in enough matter to go supermassive in a relatively short period of time.

According to astrophysicist Shantanu Basu of Western University in London, Ontario, this would only have been possible in the first 800 million years or so of the universe. "The black holes are formed over a duration of only about 150 million years and grow rapidly during this time," Basu told Live Science in the summer of 2019. "The ones that form in the early part of the 150-million-year time window can increase their mass by a factor of 10 thousand." Basu was lead author of research published last summer in Astrophysical Journal Letters that presented computer models showing this version of direct-collapse is possible.

Another version of the theory suggests that the giant gas cloud collapses into a supermassive star first, which then collapses into a black hole, which then — presumably again thanks to the state of the early universe — sucks up enough matter to go supermassive quickly.

There's a problem with either direct-collapse theory, however, beyond its relatively narrow time window. Previous models show it working only with pristine gas clouds comprised of hydrogen and helium. Other, heavier elements — carbon and oxygen, for example — break the models, causing the giant gas cloud to break up into smaller gas clouds that eventually form separate stars, end of story. No supermassive black hole, and not even a supermassive star for the second flavor of the direct-collapse theory.

A new model

ATERUI II

Image source: NAOJ

Japan's National Astronomical Observatory has a supercomputer named "ATERUI II" that was commissioned in 2018. The Tohoku University research team, led by postdoctoral fellow Sunmyon Chon, used ATERUI II to run high-resolution, 3D, long-term simulations to verify a new version of the direct-collapse idea that makes sense even with gas clouds containing heavy elements.

Chon and his team propose that, yes, supermassive gas clouds with heavy elements do break up into smaller gas clouds that wind up forming smaller stars. However, they assert that's not the end of the story.

The scientists say that post-explosion, there remains a tremendous inward pull toward the center of the ex-cloud that drags in all those smaller stars, eventually causing them to grow into a single supermassive star, 10,000 times larger than the Sun. This is a star big enough to produce the supermassive black holes we see when it finally collapses in on itself.

"This is the first time that we have shown the formation of such a large black hole precursor in clouds enriched in heavy-elements," says Chon, adding, "We believe that the giant star thus formed will continue to grow and evolve into a giant black hole."

Modeling the behavior of an expanded number of elements within the cloud while faithfully carrying forward those models through the violent breakup of the cloud and its aftermath requires such high computational overhead that only a computer as advanced as ATERUI II could pull off.

Being able to develop a theory that takes into account, for the first time, the likely complexity of early-universe gas clouds makes the Tohoku University idea the most complete, plausible explanation of the universe's mysterious supermassive black holes. Kazuyuki Omukai, also of Tohoku University says, "Our new model is able to explain the origin of more black holes than the previous studies, and this result leads to a unified understanding of the origin of supermassive black holes."