Patient Must Come First in Value Based Care

Dr. Sachin Jain wrote an outstanding article on Value Based Care in the April 12, 2022 issue of Forbes stating that the Patient Must Come First in Value Based Care.

Dr. Jain is the CEO of the Medicare Advantage Plan SCAN Health in Southern California.

Dr. Jain Outlines the 7 Tenets of Value Based Care:
A) Managing Hospital Bed-Days
B) Requiring Specialist Referrals
C) Narrow Networks
D) Team-Based Care with NPs, PAs, RNs and MAs
E) Low Cost Prescription Formulary
F) Addressing the Social Determinants of Health
G) Prioritizing Revenue and Profit

Here are 3 Suggestions for how Value Based Care can have the Patient Come First:
1) Put Physicians on Salary and have the variable component of their compensation be made public.

2) Have a 3rd Party Ombudsman that any Patient, Doctor, Nurse or other member of the healthcare team can contact at anytime if they feel a patient is not being put first.

3) Require all doctors, nurses, healthcare workers, administrators, insurance employees and government officials involved in Value Based Care to be on a Value Based Care Insurance Plan themselves.

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[kugurav]

Very thoughtful article and great analysis by Dr EB. There has to be a balance- Too much FFS mentality is not good (like unnecessary procedures), Too much VBC mentality is not good either(restricting healthcare). Incentives drive behaviors- so as a physician it should always be 'patient first'. thank you for this video

[barbgardetto]

Thank you for the video. I believe that pre-HMO insurance days were more focused on the Pt. and their needs and amt. of time necessary for care, not incentives, metrics, and bonuses. Pt.s received care, with fewer RTA's, ER visits, and prescriptions. I am happy that SDOH is being reviewed now, as it is always such an important piece to healthcare and Pt. stability in treatment.

[achievecarerpm-ccm]

I will tell you what SCAN has in place and why they understand VBC deeply. People, patients want to be at home and have their care being managed by the Health Plan that follows through with everything. SCAN looks at the bigger picture, addresses the SDOH with this Team based approach. They also have their own team of In Home Support Staff (IHSS) that visits patients at home. The State of CA asked them to participate in a combined Medi-Medi benefit called “Cal MediConnect” SCAN said NO we already have our IHSS program that is successful. The STATE does NOT. Anyway, I have huge respect for SCAN and happy that I worked there, I learned a lot.

[kendrawyatt]

This is so right on for Pregnancy. Happy Late Black Maternal Health Week. Purchasers why don’t we have value alignment in Maternity Care? Are you ok with having the worst outcomes in the industrialized world? There are plenty of provider networks made of Midwives, OBs, MFMs and hospitals working together for better outcomes. Employers and Medicaid you have a fiduciary duty to demand better results. Are you ok with the current state? Demand better ! #cmmi #onc #hitech

[nena]

I love your videos for my master's program ❤️ 💕.
My 3 favorite F word is "free", "food" and "fun.. you give me 2 of them free and fun..
Love you enthusiasm.. 😂.. animated lecture 👌

[drshanep]

Not sure how this all works out in the payment system. Moat family practice and primary care offices run on thin margins with nasty overheads. How does a clinic pay for refrigerators an iPads or other SDOH? Who pays the 3rd party Ombudsman manage pt first care? And also, we frequently have pts demand referrals to specialist or demand specific high costs meds or high dollar imaging tests. It's serous work to talk them down. Sometimes it doesn't work. Therefore, defining quality in primary care is very difficult. No simple formula and can't be simple based on A1c scores, BP numbers and vaccine rates. SODH can all crush those numbers for a doc.

[josepaulloor]

Blitzing the office that would be draconian

[Ridicvideo]

I beg to defer with your suggestion #1

[sanadbenali]

What's the variable component in suggestion 1 examples please

[magicjuand]

at a fundamental level, the same type of problem occurs in fee-for-service or in value-based care, which is the principal-agent problem.

whenever you have an agent making economic decisions on behalf of another principal stakeholder, there *will be* conflicts of interest. you can't rely on any code of conduct or clever administrators to make those conflicts disappear.

so i like the RRT idea you have here. but i tend to favor the idea that there should be money allocated for patients to proactively make such decisions. if pressing that button loses money for the hospital and you give it to employees of that same hospital, there will be pressure not to press it. if you give it to the patients themselves, then it's a free button to skip the line and go around the system.

if you make it a limited resource that patients can spend, they can decide for themselves if they really need to see that specialist or have that extra bed day despite the calculation made by their value-based care provider.

[crazydiamondUSA]

I imagine your ideas regarding outcomes-incentivized pay, utter transparency and 'for thee but not me' suggestions go over like a lead balloon in provider populations, lol. I am one of those annoying service user policymakers, 25 years at the public mental health table in Colorado. The fiscal argument I use against VBC or VBR is that EXACT thing; especially true if you do not put complex outliers first & foremost, because they then morph into "high utilizers" who suck capitated managed care systems DRY. (I put "high utilizers" in quotes because I think the term, "system failures" is more accurate & puts the onus where it belongs but then no one will understand who I mean) Of course, in carved out behavioral health, your system fails will eventually be absorbed into corrections or at the morgue so there is not a lot of accountability for failure, and the entire industry had to attract & maintain the walking wounded in order to keep the capitated wheels rolling, shuffling people into lifelong treatment for bumps in life's road - they had to! - so the outcomes focus is on those folks, the bad divorce or difficult pet death set. This is not what that specialty was carved out for, not the intent of the design. I remember in the late 80's when the dual-eligible "high utilizers" were responsible for over 90% of Medicaid spending in the public mental health industry; it is over 50% today, still unacceptable. Anyway, I can't imagine a more brilliant illumination of your theory than psychiatry! From the subjective diagnostics to the hit or miss prescribing practices, there is hardly any medical system that screams "individualization!" more loudly. It is the most costly silo to skimp on, one that can bring down the whole farm when neglected, and I will tell you from the streets, it ain't working to pound exquisitely sensitive, complicated psychiatric outliers into tiny little best practices holes.

[dblev]

It seems like this is the video that should be titled: arguments against value based care. What happened to the Nuremberg Code? This really seems quite frightening to me, because it seems like it takes the power out of my hands to fight for myself. Seeing how drug companies already don’t want to cover name brand drugs, if I have a good doctor, and a some perseverance on my part, I can still get the medication I need for my condition. Value based healthcare puts me at the mercy of a limited scope of medical professional teams who might share my values? I can appeal to a patient advocate, but whose side are they truly on?. Will they truly advocate for me, or will it be more like a present day hospital based patient advocate? Im not cheerleading our current system, but calling something value based doesn’t suddenly inspire morals and integrity to those corrupt individuals who broke our current system. If this system negates the authority of the Nuremberg Code, the trade off could be much worse than our present system!

[presterjohn]

Wendell Potter exposed the industry is one fell swoop.

[presterjohn]

Value in putting patients first? Won't happen in a market based system. Profit is the priority. The patient is simply a means to reach quarterly goals. The rest is window dressing to give the illusion of care.