A Question Worth Answering

If you ask any recently graduated medical professional what they think about “value-based healthcare” two things will likely happen. First, you will be greeted with a contentious look of disdain. You are probably not the first person to ask them that question, they did just finish school after all, so it’s a good idea to give them a little slack. After the look you will likely be given a brief lecture that usually boils down to one simple statement. Value-based healthcare simply makes sense.

Despite the fact that the concept started taking hold over a decade ago, value-based care hasn’t really made its way into the mainstream vernacular. You could argue that the reason is that the concept is somewhat complicated and not well defined but I am not sure that is the case. It seems much more likely that most people assumed that value-based care was what they were already receiving from their healthcare providers.

If you aren’t in the healthcare realm (providers, payers, insurance, compliance, etc.) then I’ve probably lost you. You’re probably asking “What is this value-based stuff?” and “Who is this guy anyway?” I’ll answer the second question first mostly because it is easier to answer, but also because doing things backwards is fun. I’m Dr. Kevin McCash and this is my new blog. In the interest of full disclosure, I am not a medical doctor, but in fact, a physicist that now works in health related data analysis. If you want more details about me, for whatever reason, you can take a gander at my bio. Go ahead. It’s short. I promise.

Now the first question, in case you hadn’t guessed, is the point and purpose of what I am writing now. This blog is my attempt to bring some of the finer details of value-based care and what it means to the public at large.  Hopefully through discussion of how it’s being applied and explored I can let a few more people into the “secret” that is changing the healthcare world. That being said I still haven’t answered the question.

So, what is value-based healthcare? In the most straightforward terms it’s a concept that would reward healthcare providers for providing the most effective and high-quality course of care for each patient. In contrast a fee-for-service model would pay a provider for what services they provided or procedures they performed regardless of the outcome. In a value-based environment, a patient would only receive the tests, services and procedures that are necessary to provide effective care and promote general well-being. Value-based care is such a profound paradigm shift that it makes you wonder why it has taken so long to come about. It’s a method that is driven by an age where information is a commodity that everyone can afford and by a public that is more connected than ever before. It is an attempt to stop the ever increasing cost of healthcare in this country but also provide the best overall benefit to patients everywhere. As those recent med school grads will say, the concept makes sense.

Remember though just because it is now possible does not mean that it is easy to implement. It is the challenges, innovations, and emerging realizations of value-based care that I want to explore, discuss and debate. I hope you will join me and maybe with a little luck we can all learn something new.

Our Authors

CindyJones

Cindy Jones, CPC, CPMA, CPC-I

Cindy Jones is a coding instructor for Health Integrity, as well as a certified medical auditor assisting the medical review staff with integrity audits. Cindy is an avid cook and has an easy sense of humor. She brings this warmth to her classes and office environment, fostering a pleasant learning experience for her students and a smile to all that meet her.

Before joining Health Integrity, Cindy worked with several hospitals managing their quality measure collection process and oversaw several primary care practices. After spending more than 20 years in various aspects of the medical industry, she brings broad perspective and valuable experience to coding instruction and medical audits.

AndreaLewis

Andrea Lewis, MS

Andrea Lewis joined Health Integrity in 2014 and is currently a Project Director.  Andrea leads a team of project managers, statisticians, and data analysts. She has a Master’s degree in Biometry and Statistics from the University at Albany, New York.  With over 12 years of experience, Andrea has worked with the New York City and State Departments of Health as well as New York State Medicaid and in the field of electronic health record data.

Being a city girl at heart, the only thing that could take Andrea away from her New York roots was love.  Andrea moved to Maryland with her husband in 2014 and has been with Health Integrity since.  While she thoroughly enjoys identifying fraud, waste and abuse in Medicare, Andrea also loves going to the gym.  She has only been twice this year because her new fitness coach is also her baby girl that keeps her running all the time.

KevinMcCash

Kevin McCash, PhD.

Kevin McCash is a data analytics manager, an avid reader and trivia buff. Kevin enjoys friendly arguments, deep discussions and above all learning new things. Kevin joined Health Integrity in 2014 as a data analyst working on the development of national scale fraud detection algorithms and production data aggregation schemes.

Prior to joining Health Integrity, Kevin was a graduate student at the University of South Florida where he received his Ph.D. in Applied Physics. In his free time Kevin enjoys spending time outdoors with his son and watching his favorite television shows.

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