As a practicing physician for more than 30 years, I have seen a number of changes occur in the healthcare industry. None of these changes have been as significant as the current transition from fee-for-service to value-based care.
It is no secret that with the price tag and inefficiencies, the current U.S. healthcare system is unsustainable. The traditional fee-for-service model, which focuses on treating acute conditions and rewards providers based on the number of services they provide, no longer works. Fortunately, the industry is shifting toward value-based care, which focuses on prevention and wellness and rewards providers for keeping people well and out of the hospital.
Major health systems like Greenville Health System (GHS), of which I am a part, are slowly but surely making the transition from volume- to value-based care. This type of transition is a huge undertaking and further complicated by the fact that the industry as a whole has not made the transition yet.
It’s as if we have one foot in the canoe and the other on shore. We are preparing for a future that has not fully arrived, but it is one that we are betting on because we believe it will have a tremendous impact on the health of our nation.
GHS and other healthcare providers have made significant investments and progress in changing their business model as part of the transition to value-based care, but that progress has the potential to slow or stop completely if President-elect Donald Trump, his administration and Congress choose not to stay the course.
To understand the importance of this transition and what’s at stake, consider what a system like GHS has done and is doing to prepare for value-based care. We have spent millions on information technology, built partnerships with area colleges and universities to develop the healthcare workforce of tomorrow, and hired hundreds of clinical staff members to develop innovative treatment models and revamp delivery system infrastructure. Despite this progress, we still face significant barriers, including limited access to claims data, risk-based insurance contracts and investment capital.
It is critical that the progress and momentum by GHS and other healthcare providers does not stop, though it appears to already be slowing. A recent report from the American Medical Group Association indicates a slowdown is already occurring as a result of the barriers I mentioned above.
To ensure progress continues, members of the Health Care Transformation Task Force recently penned a letter to Trump, his administration and Congress. The letter asks for a positive signal that the transition to value-based care will continue uninterrupted and for leaders to reaffirm their commitment to a modern payment and care delivery model that provides high quality care at an affordable price through a competitive marketplace.
Now is not the time for policymakers to waver or reverse course. Doing so would send a negative message to the healthcare industry and chill ongoing transformation efforts. What we need now is continued action. The status quo is no longer acceptable.
As a country, we spend far more money than others on healthcare, and yet our citizens have the worst health status among economically developed nations. This has to change. We can do better, and we must.
As a physician, my patients count on me to deliver the highest level of care possible. They also expect this care to be delivered in a way that makes them feel valued, respected and taken care of, and at a cost that they can afford.
The employers I work with feel the same. They want to know that their employees are receiving high quality care at a cost that won’t force them to go out of business. Frankly, it’s not a lot to ask, but it won’t be possible until we, as an industry and a country, commit to modernizing the current payment and care delivery system and focus our collective efforts on keeping people well and out of the hospital.
Angelo Sinopoli, M.D., is a pulmonologist and vice president of clinical integration at Greenville Health System in Greenville, South Carolina. He is also a member of the Health Care Transformation Task Force, a 43-member coalition that brings together purchasers/employers, payers, providers and patients/consumers to work collaboratively to promote the transition to new payment models that foster value-based care.