The American healthcare system has been characterized as dysfunctional and inefficient for many decades. Industry insiders and outsiders are frustrated and confused as to why the atmosphere is a regulatory labyrinth that is constantly changing its requirements for payers and providers. For healthcare to become better at making us healthy, the approach needs to be changed.
Healthcare professionals are hooked on the idea of value-based care as a solution to the current system. Shifting away from volume-based care to value-based care would be an exemplary accomplishment for all Americans’ health, but it’s very difficult to actualize. Some of the barriers that prevent value-based care from becoming the norm include data collection and integration, fluctuating legal requirements, and inadequate resources.
Data collection and integration in the medical field is an extensive problem. Staff across different clinical settings are not trained to enter information in a consistent fashion, increasing the complexity of attempts to share information and coordinate care. The sheer volume of data that is collected per patient also leads to much of it being lost or ignored in the patient’s movement between networks of providers.
On top of these issues lies regulatory frameworks that are always being amended. Insurance payers release thousands of new rules for providers annually and patients change carriers almost every three years. Providers are struggling to comply with these changes each day. Their staff can barely provide adequate care, meaning that any attempt to integrate value-based methodologies is quite challenging. Especially since most of these providers are relying on overburdened medical professionals to do the heavy lifting.
While value-based care can lower healthcare costs and improve patient outcomes, it provides less reliable revenue streams for stakeholders. With higher financial risk, providers with already thin profit margins are hesitant to make the switch.
In the face of these challenges, experienced healthcare technology strategist Tim Breaux is bringing awareness to why value-based care shouldn’t be our healthcare system’s highest priority. Breaux has decades of experience advising clinical technology planning, implementation, and program management. Throughout his career, Tim has seen the deep fractures of the American healthcare system. Many of them could be addressed by value-based care, but Tim argues that the transition's value is often overestimated.
“Accountable care, or value-based care, might evolve how healthcare in our country operates, but it doesn’t bring as much value as people may think,” says Breaux, “The objective is indeed valuable; the question is really whether there is a reasonable cost and benefit outside of a small number of clear beneficial use cases. Instead of focusing on value-based care, I advise clinical professionals on strategies for implementing solutions that provide near-term value, unlike value-based care. Decreasing emergency visits and assisting patients at home post discharge to mitigate the risk of readmission are two high priority objectives for almost all providers. However, each clinical setting will have a small number of objectives for cost/quality improvement.”
As an example of a key business process changing the financial benefits of these changes, Tim suggests primary care providers stop referring after-hours calls to an answering service unless the service is trained not to automatically refer troubled patients to the emergency room. Since not all patients are suffering from life-threatening conditions, Tim believes nurses with patient chart access should provide personalized advice. By training physicians to write clear, concise patient-specific clinical tactics on a patient’s chart, the after-hours nurse’s work will mitigate costs while providing patients with more precise recommendations.
Tim says these tips reflect his overall approach at InterCase, his healthcare consulting firm that strives to implement tools and services that reduce patient care and operations costs while improving care quality. Tim works tirelessly to educate providers on how they should organize care and utilize data. These overlapping actions create long-lasting change that can improve patient care and simultaneously improve profitability while minimizing complex data-sharing activities.
The American healthcare system is famous for its fragmented care delivery and lack of affordability. To become more patient-centered, accessible, and affordable, the system must undertake significant reforms. While these reforms are being implemented, providers can improve their existing performance by reducing acute facility costs and optimizing primary care. These changes can improve patient satisfaction and decrease costs, particularly for those patients with vulnerable health conditions.
Media Contact
Name: Tim Breaux
Email: tim.breaux@intercase.org
Published by: Pathos Communications Ltd