Is Value Based Care a Tortoise or a Hare?
Recently, my son has been listening to an adaptation of the classic story the tortoise and the hare. For those who may not remember the story, or have not listened to/read it recently, it is the parable for slow and steady wins the race. In the story, the hare (the fast animal) challenges the tortoise (the slow, plodding animal) to a race. As expected, the hare races off to an early lead, while the tortoise starts with and maintains a slow and steady pace. The hare quickly runs out of energy and falls asleep. The tortoise keeps the same pace and finishes the race ahead of the hare.
What does this story have to do with shifting healthcare to a value based care system? Expectations and hype (the hare) cannot be allowed to overcome practical, thoughtful adoption (the tortoise). No change, especially fundamental change, can be expected to occur overnight. It takes time for reform to seep in, be implemented and be refined.
A recent joint survey by Quest Diagnostics and Inovalon shows slow, but growing acceptance and recognition that value based care is here to stay in healthcare. In comparison to the 2016 version of the survey, more physicians (and health plan executives) see that the tools are in place for value based care.
Specifically, newer physicians are more apt to think that the American healthcare system is becoming value based. Thirty-one percent (31%) of physicians with 20 years or less of practice think that there is a value based care system. The shift in viewpoints is important because those physicians with fewer years of experience are the ones who will need to work within the new system for the longest.
An increasing percentage of both physicians (2017: 43% v.s 2016 29%) and health plan executives (2017: 53% vs. 2016: 44%) think that physicians already have the tools to succeed with value based care. However, as pointed out in the survey, misperceptions about the current benefit provided by electronic health records fuel the rosy view among health plan executives. Somewhat surprisingly, 54% of physicians believed that EHRs have everything that physicians need. However, 70% of physicians also did not see a clear link between EHRs and improved patient outcomes. The disconnect is not easily explained by the survey results, but a quick scan of common complaints voiced elsewhere supports the lack of connection for improving care.
Searching for a silver lining though, the fact that over half of physicians think that EHRs already have everything that is needed shows the remaining capability. As EHRs are slowly refined and modified to fit within practice workflows, the benefit for value based care should become more readily apparent. A common talking point is that technology takes multiple iterations before it begins to approach promised usability. EHRs, a digital technology, are no different from the technical perspective, but not in the use perspective. While people complain if their iPhone or other modern device does not perform as advertised at first, the medical industry cannot afford to have tools that impede or subvert practice.
Ultimately, the Quest/Inovalon survey is hopeful. Views of value based care and the supporting role that health IT can play are trending upward. Additionally, the views are changing at a measured pace, which suggests that unfounded expectations are hopefully coming down to reality. Dreaming is good, but can cause frustration. It is important to think of the tortoise’s approach that one foot in front of the other at a pace that can be maintained for a long time is often the way to win the race.
About the author: Matthew Fisher is the chair of the Health Law Group at Mirick, O’Connell, DeMallie & Lougee, LLP, in Worcester, MA. Matt advises his clients in all aspects of healthcare regulatory compliance, including HIPAA, the Stark Law and the Anti-Kickback Statute. This article was originally published on Mirick O’Connell’s Health Law Blog and is republished here with permission.