Value-Based Healthcare Models Demand Inclusion And Individuality – Forbes


By S_L

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If you’re paid by the test, you’ll conduct more tests. Your business model will be centered around performing tests more efficiently, with various departments perfecting their own specialized tests. There will be billing codes, skills training, and benchmarks marking the milestones toward a higher volume of tests.

This is not a judgment of character, this is simply the result of a system performing according to its own rules. Healthcare providers have spent decades building business models focused on increasing volume. It’s no wonder we have a system that treats a 24-year-old diagnosed with breast cancer the same way it would treat a 50-year-old with the same diagnosis.

The system is built in a way that makes it hard for institutions to see and treat people as individuals. No matter how much an individual doctor or nurse may care for patients as the unique people they are, those same doctors and nurses (and all care providers) still have to function within a system built around billing codes and line items and volume.

But the industry is changing, or at least trying to. A big challenge in healthcare now is how to shift entire enterprises that are organized around that volume-based, fee-for-service model to a model that focuses on value—in other words, one that rewards providers for keeping people healthy. The goals of value-based healthcare are to improve the health of a population and provide a better experience for patients, employees and communities—while managing costs efficiently.

Given these systemic problems, this shift to value-driven care is an enormous challenge.

The Importance Of The Population In Addressing Value-Based Medicine

We can’t talk about improving the health of a population without talking about the population itself. I have discussed population health from a few different angles in the past: how population health offers critical lessons for the future, part 1 and part 2; and how to make population health a brand strategy.

Simply put, in the United States we’re in the midst of a Cultural Demographic Shift that is affecting all industries — especially healthcare, where cultural differences affect how people seek care and where they get their health information. The Cultural Demographic Shift is what happens when large cultural segments of the population reach critical mass or numbers sufficient to have a significant effect on what we do and how we act. According to the U.S. Census Bureau, the United States is projected to become a majority-minority nation for the first time in 2043. While the non-Hispanic white population will remain the largest single group, no group will make up a majority.

But don’t let that future date fool you. The impact is being felt now. According to a report published by the Selig Center for Economic Growth, minority groups are making the fastest gains when it comes to buying power in the United States: since 2000, the buying power of Asian-Americans increased 222%, for Hispanics it increased 181%, for Native Americans it increased 164%, and for African-Americans buying power increased 98%. For comparison, during that same period the buying power of whites increased 79%. Hispanics alone have accounted for nearly half the U.S. population growth since the 2010 census.

Why does any of this matter? Addressing the Cultural Demographic Shift goes hand-in-hand with addressing population health management. In fact, you can’t even begin to bring value to a population of people you don’t even know.

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