Humana asked experts to define 'value-based care.' They couldn't do it

Humana convened some of the healthcare industry’s greatest minds to build a consensus on the definitions of oft-used but rather nebulous concepts such as “value-based care” and “population health.” 

There was just one problem: The experts couldn’t figure it out, either.

Humana released a look at the results of the panel’s discussions first to FierceHealthcare, and although the participants could find common ground on what “value-based payment” is, they couldn't agree when it came to “value-based care” or “population health.” 

The 18 panelists—which included representatives from Humana, the Robert Wood Johnson Foundation, the Geisinger Health System, the University of Pennsylvania and Centene Corporation—agreed, for instance, that value-based care would apply to both individuals and populations and would be determined by outcome and cost.

But they were divided about whether patient experiences should be highlighted or whether there should be a duration factor in calculating value. 

RELATED: All but 4 states using value-based payment models, report finds 

“I was actually a little surprised,” Meredith Williams, M.D., market president for Humana based in Louisville, Kentucky, told FierceHealthcare. “I thought there would be more consensus. It was a very revealing process to all involved.”

Similarly, panel members agreed that "population health" refers to the health of groups rather than individuals but were split on whether and how to best incorporate the social determinants of health as well as how to group people for population health initiatives.

The discussions were held as part of the Delphi process, a research model that aims to create definitions. Previous Delphi research in healthcare has been used to reach clinical consensus on certain treatments and define concepts like “advanced care planning.” 

That payers and providers may have different perceptions of things such as value-based care may be no surprise. Why did Humana invest its time and resources into asking such a question?

For one, Williams said, a lack of consensus can hinder progress. 

RELATED: A shortage of data scientists could be holding back advances in healthcare 

She said Humana would meet with different partners to discuss new projects, but they weren’t always on the same wavelength—and that can hold back potentially significant initiatives to reduce costs or improve outcomes. 

“We found that as we were working with different partners, we were using the same words but we're just not sure they were interpreted the same way,” Williams said. 

That realization led the team to dig deeper to see whether this is a more widespread issue in the industry—as the study uncovered, she said. 

What can insurers do to bridge these communication gaps? Start by acknowledging them, Williams said. Beginning the conversation about a new partnership by ensuring everyone is on the same page is crucial, she said. 

In addition to these specific gaps in communication, the study highlighted just how valuable it can be for industry leaders to convene with others who may not share the same perspective, Williams said. 

“That’s really, I think, a very promising trend for the industry," she said. “We’ve not always had very strong relationships across different teams.”