Value-Based Care: Business Case AGAINST It
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- Опубликовано: 27 фев 2021
- There is a Business Case Against Value-Based Healthcare.
Journalist Marshall Allen from ProPublica Highlighted How 2 Value-Based Care Solutions Were Rejected by Healthcare Companies: More Efficient Eye Droppers and Multi-Use Chemotherapy Vials.
Businesses Constantly Strike a Balance Between Value Creation and Value Extraction. The Fiduciary Responsibility of Healthcare Companies to their Investors and Shareholders Requires Them to Extract as Much Value as Possible vis-a-vis Their Value Creation.
While the Above 2 Examples May Have Been Good for Patients, They Did Not Result in Increased Value Extraction for the Companies... Hence, They Did Not Happen.
Accordingly, Value-Based Care May Be Good for Patients, But It is Not Good for Healthcare Businesses.
Any Healthcare Company That Claims to Promote Value-Based Care Needs to be Viewed with Skepticism.
Sources: • How drug companies mak...
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#HealthcareCosts #ValueBasedCare #ValueBasedPayments
The issue is that many people don't actually understand how value-based care works. An MBA no matter how prestigious the university will never understand how system works, you need hands-on experience. I'd rather have a low tiered MBA with 3-5 years of experience running an IPA,MSO, private practice. Value based care really comes down to understanding risk-adjustment and managing providers/networks. If you work on the primary care side of the business your job is to negotiate cheaper contracts for specialists and reduce hospitalization. The value you produce by reducing costs is then taken as gains, there is plenty of money to be made in value-based care, but it requires more knowledge than your typical RVU/FFS model.
Excellent points. Thank you for your perspective.
Well said, ❤
“If you are a business you want to be as close to the theft side as possible” IM SO SICKKKK HOW CAN YOU SAY THAT IN THE CONTEXT OF BEING IN THE BUSINESS OF HEALING SICK PEOPLE AND STILL SLEEP AT NIGHT.
Thank you for sharing your thoughts.
Thank you Dr. Eric. I understand your views on VBC being not a great model and why our healthcare ecosystem is in part dysfunctional because of extreme difference of position between cost containment for payers and revenue pressures for the provider. With VBC not being the best solution, I wonder what that says to the 50M members who are enrolled in a MA plan.
They need to be very closely watched.
Thank you, Dr. Bricker, for another thought-provoking insight. As one who has to use those said eye drops, I'm so frustrated by the fact that the micro-dropper isn't in use! I have other eye issues because of the eyedrop running on the outside of my eye. This could be prevented. Ugh!
Ugh is Right! Thank you for watching!!
I love how unironically you state if you're publicly traded, you want to be as close to theft as possible.
Thank you for watching. Just my opinion. 😉
The point of value-based care is to realign incentives between payor, provider, and patient. In FFS a provider has no/low incentive to heal their patient. Extracting as much "value" from a patient as possible is how defensive medicine came to be. It leads to an unending cycle of increased costs to all parties involved. Value-based care changes that, and instead targets at extracting value from the wastage and inefficiencies of the FFS system.
Thank you for sharing your perspective. Appreciate you watching.
You must be an administrator. You are espousing a highly cynical view of physicians (“a provider has no/low incentive to heal their patient.”)
For the individual provider, the duty to the patient trumps incentives. The institution who follows only incentives has abandoned or refused it's duty so there is nothing left to stop it from value extraction. Individuals should be distinguished from groups here.
Thank you Dr. Bricker for another great episode!
Thank you for watching and for your feedback.
Dr. bricker for the past 2 years I have been pursuing MHA and the only buzzwords are Value-based care and Telemedicine, I never understood (was skeptical) how hospitals will make profits if they implement this model. I had thought that they might increase the volume of diagnostic centers and implement the model of proactive healthcare. but still, that won't make profits as much as FFS. Your videos cleared doubts. Thanks and hope to see you more.
Thank you for watching and for your feedback.
I think it's a smokescreen and PR campaign. Hospitals would only pursue this if they were government owned and run. They just want a few tweaks from the government so they get back some control of the flow of dollars from the insurance companies.
Another great visual aid presentation! As we have discussed previously, how is it that the BUCA's (BlueCross/Shield, United Healthcare, Cigna, Aetna) really want "claims costs" PMPM to decrease when the only way for them to show revenue increase to their stockholders is to allow an increased flow of premium/claim dollars to flow through their hands? Cheers.
You are correct. Thank you for watching and for your comment.
I’m not sure I understand and trying to learn. Can uou explain this? Isn’t that claims costs pmpm are the expenses for them and they want to decrease that through value based care? Overall the value based care is reducing the reimbursement costs from the payer and split that saving to reward provider
@@ahealthcarez they can potentially make some of that up with shared savings programs (e.g. with the providers)
There are many VBC "enablers" getting funding from Silicon Valley now. This video is so timely.
Thank you for watching and for your feedback.
Dr Bricker, I dropped in to view some of your videos on Healthcare as I am doing a Columbia Exec Certification Program on Healthcare. Your points are right on and very thoughtful viz., Value Creation vs Value Extraction. Healthcare industry seems to be in value extraction business (aka theft) because the big Momma (Medical, Medicare) has thick, fat purse
Thank you for watching and for your comment.
I really enjoy your videos. I’ve watched nearly all of them. While I understand what you’re saying. I am curious if you are assuming that building a benefits plan based on high quality fairly priced managed care facilities is futile, because of the way the system incentives a continuously higher price structure. Given the insurers are handicapped by the MLR Rules set by the ACA. So attempting to identify high quality low cost facilities is a futile approach when constructing a plan?
Correct… through the carrier it is futile. Like Walmart, employers can do it on their own outside the carrier for steerage and bundled-pricing contract purposes.
Thank you for watching!
Understood & agreed.
Hello Dr. Bricker,
I am a medical student that just found your videos. They are very informative! I am interested in getting my MBA as well. While I see your point that a business wants to be on the "theft" side of the spectrum, in the examples you gave towards the charity side like food and gas there is plenty of money to be made in those industries as well. So while they would make more money if they increased margins (more value extracted), they still make incredible amounts of money. Therefore, isn't it possible to establish value-based care practices and services, and still maintain a sustainable business model?
Either way, thank you for your videos. I enjoy them a lot.
Thanks so much for watching and for your comment.
Value-Based Payment works if it is Capitation or what is now called ‘Full Risk.’
The challenge arises when groups that claim to be doing value based care in reality are not.
In healthcare, double-speak is common.
Best of luck to you.
Run away dear student!
I don't believe it is true that a provider can bill a patient for wastage when utilizing a partial vial of Herceptin (to use your example). Commercial and Medicare payors generally ask that you code a specific way, and then bill the plan themselves for the wastage as a separate line item.
Please correct me if I'm wrong. Thank you.
Per Marshall Allen’s reporting, that is not the case. I do not have any additional sources to confirm.
Appreciate you watching and leaving a comment.
@@ahealthcarez very same, thanks much for your candor. Love what you are doing.
@@ahealthcarez after researching, I found out that you are 100% correct! Your humility is much appreciated :)
As to waste billing, the criteria (I'm sure you know) include that doses are administered to OPs and include drugs that are separately-payable. Waste billed needs to post on a separate line item with the appropriate JW modifier. Once billed correctly, though, adjusted charges for waste billed drop to secondary payors when available and ultimately to patient responsible buckets along with any other service/product charge that is deemed 'covered'.
Doesn't seem appropriate, but there you have it. Thanks again.
Can the medication be extracted the same way blood is drawn to get all of it at once?
I don’t know.
While I think we can all agree that there is waste and over pricing from a value creation side in health care, we need to understand those driving forces between the companies that create value for their shareholders and those clients they serve. When you have the government publicly stating they can NOT negoiate prices on RX (via Medicare) it invites the companies to extract all the money they can out of the system. And while we are one of the only counties in the world that still does RX development, RX for many becomes almost impossible (without insurance) to purchase speciality RX. The situation is out of control. And I dont see any near term fix either.
#Agreed. Unfortunately, it is likely to get worse before it gets better.
Ok, I see what you’re getting at.
If there are any benefits from VBC, the middle men, the health insurance companies, will see those benefits, not the providers or the patients.
I know that so far, VBC is a ton of work for very little reward for providers. If the providers are making the big changes, hiring coders and CDS’s, improving their documentation, then you would think THEY would see the benefits, but instead the health insurance companies do.
Yep, I feel like a loser.
Thank you for watching and sharing your thoughts.
Are you a provider? How is value-based care different in terms of workload from fee-for-service?
@@olilumgbalu5653 fee-for-service rewards each service performed.
Value based rewards based on the health of the patient or how complex the case is.
That’s a bit reductive, but in general, that’s the concept.
I have so many questions!
Good. Appreciate you watching.
Or the US could finally decide that healthcare is a human right and not an obscene industry with the worst outcomes in the developed world while spending more than any of them. The LS companies would be reigned in as well.
Thank you for watching and for your comment.
Quite the opposite. A large proportion of very successful business try to provide extensive value for their customers. They know by providing a quality product or experience at a reasonable costs leads to long term success in business.
Thank you for watching and adding your thoughts.
Wonder what the AWP is on this drugs.
There is value to it
Thank you for sharing your thoughts.
Dr Bricker's content is fascinating as a healthcare consumer who just turned 65 and has happily fallen down the All Things Medicare rabbit hole on RUclips. And I’ve found all Dr Bricker's RUclipss **extremely** insightful into the healthcare industry - how it rolls. But this one I must admit was disturbing, as in what is Dr Bricker advocating here? Greed and continued malfeasance *towards* the end user, employers and employees? Seems totally out of character on this video. I was expecting at least some HOW to make the case. And maybe a case for true Non Profits. Etc. Topic suggestion: a DEEP dive into “Baumol's (Service Cost) Disease” that is covered in MBA Finance courses, where Higher Education and Healthcare are the leading “disease” practitioners. My take: out of control incentives on steroids. Challenge is how to fix them via Capitalism run amuck. We have a GREAT YT channel here, keep it rollin'!
Thank you for watching and for sharing your thoughts.
V = Q/C
Thank you for watching and for your equation. 💪
Facilities make more money on NICU stays. Plans rent their networks to the Jumbo employers on percent basis.
Pregnancy care and outcomes completely misaligned.
And CMS/CMMI totally ok with it.
Both parties are complicit.
American people lose.
Thank you for watching and family your comment.
Highly controversial, because its so true
Thank you for watching and for weighing in.
Wow, this analysis is extraordinarily cynical but - where's the lie?
Thank you for watching and for your feedback.
Silly me I thought you were actually going to try make a legitimate argument against value based care. For example many people were denied organ transplants during covid for not being vaccinated. Is this value based care? If suppose a value based model could encourage possibly determine the medication an epileptic patient would be allowed to take. Sometimes value may come at a risk to the patients health! In reality value based healthcare is taking the worst from the current model and enhancing it. Drug companies already do all they can to prevent covering high cost name brand drugs. But these imposed decisions should not be left in the hands of pharmacies or medical consultants. Value based healthcare will eventually lead to offering patients MAID (medical aid in dieing) as a value based option! The pay based model may be greedy, but the value based model may end being void of any all values.
Thank you for sharing your thoughts.
Well yes and no, you want to be on the theft spectrum if you are that archetypal greedy billionaire without rivals
Who doesn't have rivals?
Moderation is key you would extract that value only to create more value simple supply and demand
Appreciate all your comments!!
@@ahealthcarez dr bricker am new to this discipline all that I know is from reading and youtube videos
In my country we are going through a major reform we were on salary based but it was bad for reasons then the private sector took off we did pay for service but it was out of pocket and it was terrible
You on the other hand have real already applied knowledge and data to support
Am going to watch all your videos and am glad you are responsive in the comments
@@ahealthcarez I have a question If I may ask
Does the US system give incentives to doctors to actually fix underlying causes does a doctor benefit anything if their patient quits smoking because of them or loses weight or successfully learn to manage stress
Omg if anyone is reading this please understand this man has no idea what he’s talking about. It’s honestly cute lmao