Mara McDermott, Vice President at McDermott+Consulting, shares what obstacles are preventing us from adopting value-based care, and highlights the value this model of care has to offer.
The subject of value-based care has been a widely debated topic among the healthcare community. So, to get a well-rounded perspective on this type of care, Elise Wilfinger is joined by Mara McDermott, a health care executive and expert in federal health care law and policy. Ms. McDermott is the vice president of McDermott+Consulting, a health policy consulting firm.
Prior to her consulting role, Ms. McDermott served as the Senior Vice President of Federal Affairs at America’s Physician Groups. As the head of the Washington DC office, she worked on behalf of the Association’s member organizations to advance policies that promoted coordinated care, including working with members of Congress and their staffs, the administration, health policy stakeholders, and coalitions to advance alternative payment models.
Ms. McDermott began by defining value-based care as a “system where the payer and the provider are aligned to deliver the care needed to enable patients to lead a full, healthy life and to freely engage in all desired, daily activities,” and explained that this care model differs from the traditional fee-for-service model due to the fact that it’s no longer about one doctor or one service. Rather, it’s more of an ecosystem around each patient where doctors are incentivized to provide preventative services and encourage patient wellness.
While value-based care continues to be debated, according to data from the New England Journal of Medicine, a value-based care model has led to a sustained improvement in care and lowered costs.
Now many fee-for-service models often claim to have the same benefits, but according to Ms. McDermott, these models focus more on treating a patient’s current ailment and transitioning them to the next doctor rather than taking a more holistic approach to care and prioritizes prevention.
But with that in mind, many healthcare professionals continue to lean into the fee-for-service model, especially given the COVID-19 pandemic. This is because they had greater certainty given their per-member, per-month payment arrangement, resulting in a continued cash flow during the pandemic. Value models also supported practices and their communities by creating local care relationships and workflows that streamlined pandemic response. As a result, many physicians have a renewed interest in value-based care and value-based delivery models.
But beyond the COVID-19 pandemic, the biggest obstacle to the adoption of value-based care models: complexity. In many cases, doctors and/or their practices need to enter a contract with a payer, they need to know how to negotiate terms, and they need to assess new data sets.
After diving into value-based care a little further, Ms. McDermott concluded by discussing her work on Capitol Hill, diving into the Biden’s administration commitment to value-based care models, ending with this final takeaway:
“[The Biden] Administration has also emphasized the importance of bringing health equity into the value conversation. This will hopefully spur further adoption of value-based delivery models in underserved areas and continue to inspire creative thinking about solving complex health care problems.”