Value Based Care 3.0

Value Based Care 1.0 - Previous State When I began my career at U.S. Healthcare, they were beginning to disrupt the healthcare system. They introduced capitated arrangements with providers, which meant their payments were capped and if they wanted to make more money, they had to demonstrate better clinical outcomes. It was a disruptive business model with a significantly lower price point and little to no out of pocket expenses, it caught the attention of employers and employees. The challenge with the lower cost network, was that it didn't include every physician and hospital. Payers with everyone in the network are average, by definition At the same time, pioneers fighting to reduce cost, opened free-standing surgical centers taking procedures that didn't need to be done in a hospital and providing them at a lower cost taking the low risk procedures, like joint replacements, leaving hospitals holding the bag with low margin complex cases. Value Based Care 2.0 - Current State Costs continue to rise, but the value based care model is starting to evolve. Employers and Payers are beginning to sign VBC contracts that hold the provider accountable for results. The disruptors are the employers and payers that steer their employees to a lower cost site of care, while improving outcomes highly satisfied patients. Innovative providers have been transforming\their business models to deliver quality care at a lower cost, better clinical outcomes and higher patient satisfaction. Value Based Care 3.0 - Future State Data is shared among all players in a standardized format, providers are forced to have transparent pricing and guarantee their work. Payers will learn to administer VBC claims and will incentivize steerage to remain competitive. Individuals will have their own treatment plan and be held accountable by their employers to make good health decisions or pay the price. True disruption will occur when the value chain is aligned. Welcome to Value Based Care 3.0.