A slate of newly proposed reforms laid out by the Biden administration in recent weeks demonstrate a clear focus on value-based care moving forward for nursing homes.
Designed to improve patient outcomes by awarding financial incentives or penalties based on 30-day hospital readmission rates, the SNF VBP program, combined with the growth of the I-SNP and new ACO REACH models, show that health care is moving toward better equating value with quality and costs.
Not everybody is completely on board with the “unwavering” shift to value-based care, however.
Dr. Sachin Jain, president and CEO of SCAN Group and SCAN Health Plan, thinks a gap may be forming between the promise of what value-based care can provide and its real-world implications, according to an op-ed he wrote that was published in Forbes this week.
While he made clear that his observations should not be seen as a defense of the fee-for-service (FFS) model or a rebuke of value-based care, Jain believes groups will need to have a robust clinical and financial culture in place for value-based care to succeed and to ensure that they are managing costs in the best interest of the patient, not the financial interests of the group.
He’s seen firsthand what value-based care brings patients when it’s done right, especially when it brings non-traditional, non-medical interventions that improve patient outcomes.
“When I was at CareMore, our care management team once procured a refrigerator for a patient who needed it to store his insulin, recognizing that without the refrigerator, the patient would likely land in the hospital with high blood sugar,” he wrote.
Other examples include Rushika Fernandopulle, the founder of Iora Health, buying an Apple iPod to soothe a patient whose anxiety led him to the emergency room more than 100 times a year or SCAN’s “healthcare in action medical group” providing cell phones to patients experiencing homeless to connect them with the right resources.
However, while many value-based care organizations provide access to gym benefits, transportation, food, and other interventions designed to improve key drivers of health, the effect some of these interventions have on the cost or the quality of outcomes is not entirely clear.
In general, Jain worries value-based care may limit innovation and could be too focused on revenue as the financial bottom-line may, in some instances, go against the care the patient feels they need. Some value-based care groups only contract with a limited network of specialists and medical centers, and seem to contract with specialists and hospitals based more on cost than on quality.
Value-based care groups have even been known to avoid working with the most reputable and sometimes higher quality providers because of the cost associated with doing so, according to Jain.
“Value-based care groups can quickly find themselves at odds with their patients when their recommendations and treatment plans contradict what patients themselves learn doing their own research on the best and most modern course of action for their condition,” he wrote.
Jain wrote that patients in value-based care organizations can benefit from working with confident generalist primary care physicians who take more responsibility for patients and their outcomes, however, there can be a downside.
Patients who need a specialist are sometimes delayed getting to one – which can result in poor outcomes.
“And patients aren’t the only ones complaining. Almost every practicing doctor will tell you stories about how much work it sometimes takes to obtain approval for referrals that are absolutely necessary and just make common sense,” he wrote.
With the goal to avoid hospitalizations, value-based care organizations can be aggressive about how they manage bed days, sometimes directly admitting patients to SNFs or outpatient clinics, which Jain fears could be at the detriment of the patient.
“Such aggressive bed day management often translates into lower hospitalization rates and shortened hospitalizations, but it can sometimes leave patients and families feeling rushed and uncared for in their most vulnerable moments,” he wrote. “Patients who expect (and sometimes need) long hospital stays might be surprised when they’re discharged rapidly to their homes with home care services or to skilled-nursing facilities in lieu of an extra few nights in the hospital.”
Patients can also feel rushed down the path of palliative care and hospice when they may have a desire to keep fighting their illnesses, Jain noted.
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