By Brian Wheeler, Vice President, Provider Collaboration and Network Transformation, CareFirst BlueCross BlueShield

The pandemic has revealed hard truths about America’s healthcare system, fueling broad divides on public health issues and further complicating dialogue on the healthiest way forward for our country, leaving many yearning for clarity and decisive action.

We know the catastrophic toll that decades of unequal access to care combined with inequity in critical social factors that promote good health have impacted our population’s historically underserved segments. We continue to witness drastic disparities in health outcomes throughout this crisis. The limitations of a volume-based system have only further highlighted the need for change.

There are solutions to these challenges. Imagine a system in which: 

  • Healthcare professionals’ pay is tied to improved health outcomes for patients instead of the number of office visits, tests or procedures performed
  • Patients receive individualized care that considers their whole health as well as social factors contributing to their well-being
  • Payer and provider resources partner and focus on keeping people and communities healthy, not just treating symptoms

That system is called value-based care – and it is not a new idea, but one that is desperately needed now. As we continue to battle the pandemic, economic hardship and the unacceptable consequences of structural racism, our healthcare system must shift focus to equitable innovations in care that lead to measurable improvements for patients and communities. 

The opportunity to reimagine a new framework and build a system to emerge from these challenges healthier, stronger and with a more sustainable healthcare delivery system is present. Value-based care fosters:

  • Access. The pandemic revealed healthcare resources are often not aligned with need. Value-based care realigns resources with needs by incentivizing providers to serve vulnerable communities, lessening uneven distribution of resources and providing more financial stability for providers. 
  • Affordability. Households and businesses continue to struggle with the rising cost of healthcare. Value-based care stabilizes costs for consumers and employers, ensuring a better return on investment while improving outcomes through preventive care that addresses patients’ whole health.
  • Equity. The pandemic has exacerbated existing health disparities for historically disadvantaged populations. Structural racism has long contributed to inequities that drive poor health outcomes. Value-based care can help address these disparities by incentivizing the system to safeguard a person’s whole health.
  • Improved Health Outcomes. Would better health and fewer chronic conditions improve health outcomes, especially in a pandemic? Absolutely. Transforming our healthcare system equates to transforming the health of our communities.

Strategic partnerships are vital to shifting from volume to value to bring real change to patient and community health. CareFirst, for example, has engaged in alliances with health systems and independently-owned physician practices to improve quality, access, affordability and equity for the communities we serve.

As we continue to navigate challenges and opportunities ahead, volume-based care, high costs, health disparities and structural inequities are not sustainable. Therefore, a healthcare system rooted in delivering value and healthier outcomes is the healthier normal we need to create.

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