Value-based care has become one of the most misunderstood terms in the healthcare industry, according to Lakshmi Halasyamani, chief clinical officer at Endeavor Health.
She said hospitals tend to treat value-based care as another payment arrangement — but it’s really more of a commitment to patients.
“I think we have to evolve on the health system side — shift from it being based on a contractual relationship to it really being about our promise to the people who we’re caring for. And to do that, we really need to understand our populations. We need to understand them clinically, and we need to understand how we get reimbursed. We need to bring those things together to be able to create an ecosystem that provides value,” Halasyamani said.
That distinction matters more than ever with CMS’ goal of enrolling all traditional Medicare beneficiaries in an accountable care arrangement by 2030, she added.
That goal was set in 2021, but its future is less clear today, as CMS has yet to reaffirm that target under its current leadership. Regardless, Halasyamani said the shift makes sense for Endeavor given its own patient population. The Chicagoland-based health system’s patient base skews older and increasingly requires the kind of coordinated, longitudinal care that value-based models are designed to support, she explained.
Instead of standing up a separate value-based care division, Endeavor has folded this work into its existing quality and efficiency structures. The idea here was to think about value-based care as a lens that should be applied across all patients rather than a siloed program for a subset of them, Halasyamani stated.
The goal is to broadly align clinical outcomes with affordability, including for patients who aren’t in a value-based arrangement at all.
Halasyamani noted that means factoring in questions that don’t always show up on a claims form, like whether a patient can actually afford the treatment they’ve been prescribed.
“If I prescribe a medicine that’s $200 a month, is that going to even be filled? And if not, what are my other options?” she said.
Sometimes providers lose sight of the fact that they should be fitting a care plan into a patient’s actual life, not just their chart, Halasyamani pointed out. That thinking extends beyond prescription costs to other circumstances shaping a patient’s ability to follow through on medical advice, such as whether a patient’s neighborhood is even safe to walk during their non-working hours, she added.
That’s the perspective shift Halasyamani wants to see across the sector — from value-based care as a payment mechanism to value-based care as a genuine understanding of who a patient is outside the exam room. To get there, she thinks health systems will have to invest in data and relationships that go well beyond the traditional medical record.
Ultimately, Halasyamani said the payment structure is secondary to the underlying goal.
“Our goal needs to be to create value for everyone, appreciating that the payment models may not all be 100% aligned,” she remarked.
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