A field guide to U.S. healthcare reform: The evolution to value‐based healthcare

Abstract

Objective A consolidated state‐of‐the‐art review of U.S. healthcare reform efforts that documents the evolution towards value‐based healthcare (VBH) is lacking in peer‐review literature. This field guide attempts to clarify working definitions and conceptual boundaries within the lexicon of U.S. healthcare reform efforts that predated and have common thematic perspectives within the evolving VBH reform paradigm. Data Sources Pubmed/MEDLINE/Google search. Review Methods Pubmed/MEDLINE/Google search was performed during August 1, 2020‐January14, 2021 for U.S. healthcare reform terms, legislative and government agency publications. Those citing relevant legislative, regulatory, philosophical and technological advancements integral to the development and function of VBH were catalogued according to the targeted stakeholders and evolving reform strategy or technology. Conclusions Eight healthcare reform paradigms were identified as influential precursors to VBH: Patient‐Centered Care Model, Patient‐Centered Medical Home, Population Health, Personalized Medicine, P4 Medicine, Precision Medicine, Managed Care, and Accountable Care. Several of these models have similar nomenclature and, confusingly, many have multiple interpretations of the terms used to describe these models. However, consistent stakeholders identified within these paradigms are key to VBH; notably the patient, the physician and the payer (the “Big 3”). Demonstrable healthcare spending reductions have been best achieved when the Big 3 stakeholder interests are aligned within healthcare reform legislation. The definition of “Value” within each reform model was found to be based upon the perspective of the targeted stakeholder. Within VBH, the perspectives of the Big 3 stakeholders form a multidimensional meaning of “Value” that can be represented by the equation Value = Patient Experience Management3.

Beyond Healing: Embracing the Triple Bottom Line Approach in Post-pandemic Healthcare

“…A second key pillar as far as financial sustainability is related to what we refer to as value-based care [ 8 ], which describes how moving from a volume-based to a value-based approach to healthcare delivery might improve how we pay for and deliver care. In a volume-based setting, providers receive payments for services rather than payments for patients' health outcomes.…”

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“…Another point made by Willard C. Harill and David E. Melon, which characterizes the problems in the US healthcare at the time, was that the concept of VBHC was initially coined by Porter in 2007 in reaction to the third-party cost transfer and fee-for-service expenditure mitigation tactics employed by Health Maintenance Organizations (HMOs), which were impeding physicians' capacity to allocate sufficient time to patient care [4].…”

“…Melon regarding the healthcare reform and value paradigm in the United States, "value" is delineated as contingent upon the viewpoint of each stakeholder, encompassing "quality, service, patient experience, access, outcomes, and cost" as foundational components. The authors underscored that these reforms broadened the scope of value by recognizing patients as pivotal stakeholders, whose healthcare value is evaluated through the entirety of their clinical care journey and associated experiences [4].…”

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