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The Value-Based Care Era: Redefining Health and Healthcare

The Value-Based Care Era: Redefining Health and Healthcare

Payment models that reward value (quality/cost) have become increasingly important in efforts to overhaul the health care system. Therefore, it seems appropriate to consider what we value in healthcare, which will need to consider how we define health. Although such a viewpoint has produced tremendous improvements in medical knowledge, it may now negatively hurt value. According to how quality is defined, problem-oriented care may be negatively affecting the quality of care and being one of the leading causes of rising expenses.

Health care could be directed more directly toward significant outcomes, lowering the number of pointless tests and treatments, if health were redefined in terms of patient-centred objectives. Prevention, worthwhile endeavours, advance directives, and individual development would receive more attention. It would promote therapeutic connections by elevating the role of patients in clinician-patient interactions. Both quality and cost could be improved by redefining health in terms of health-related goals and directing the healthcare system to assist people in achieving them. Additionally, it might result in a more humanistic and less mechanical approach to healthcare.

Government and business have been working together to overhaul our health care system for about three decades now, partly due to cost concerns and because we have lagged behind other industrialised nations on major population health indicators. The “Care Model” created by Ed Wagner and colleagues and the “Patient-Centered Medical Home” concepts made and accepted by the three major primary care professional associations are recent reform techniques that acknowledge the value of primary care. Increased cooperation, information technology like electronic records, registries, and information sharing systems, and stricter adherence to evidence-based clinical practice guidelines are all necessary components of these initiatives.

The “Triple Aims,” a framework created by Donald Berwick, President Emeritus and Senior Fellow of the Institute for Healthcare Improvement and former Director of the Centers for Medicare and Medicaid Services, are being used by reformers to gauge the effectiveness of their initiatives. The Triple Aims are: (1) enhancing patient outcomes, (2) enhancing patient outcomes, and (3) lowering healthcare costs. A fourth objective, to enhance healthcare providers’ working conditions, has been added by some.

Numerous local and regional experiments have been in progress since the Centers for Medicare and Medicaid Innovations centre was established. Most of these contain incentives to motivate clinicians to provide evidence-based care and payment reforms to improve primary care (e.g., paying for care coordination and registries). Health systems, insurance providers, and new health care enterprises are all engaged in private trials, such as “Value-Based Purchasing” and “Direct Primary Care.”f

Almost all of these studies focus on cost- and care-process improvement. Expected intermediate outcomes that can be generated quickly from readily available data include haemoglobin A1c and blood pressure, emergency and hospital service utilisation rates, and patient satisfaction. Although clinicians have expressed concerns about these measurements, there doesn’t seem to be much of a desire for discussion or truly innovative alternatives because the financial circumstances are so foreboding.

Ten ways that problem-oriented care may be causing subpar treatment and higher costs

Despite the World Health Organization’s warning, it is evident that American health care is based on the idea that “health” is the absence of sickness. Most health care interventions are predicated on the idea that treating anomalies will increase length and quality of life by restoring health. Of course, the problem-oriented strategy has been quite effective in many ways. But now that we’re so adept at it, it might be causing both higher expenses and unfavourable results.

An alternate view of health and medical care

It is time to think about a different way of looking at health and healthcare that closely aligns with how people act and think. Most people see life as a journey filled with incredible opportunities and enormous challenges. They probably define health as having the ability to benefit the most from the trip. The things they value most are being able to pursue the things they enjoy and find meaningful for as long as possible, meeting, conquering and learning from the inevitable problems along the road and eventually dying peacefully having had the opportunity to fulfil their most significant potential as human beings.

Care with a focus on goals, quality, and cost

Depending on how quality is defined, goal-directed treatment may or may not increase health care quality. Quality is determined by how closely clinicians follow disease-specific recommendations and how well patients control their diseases. This idea is comparable to the definition of quality in manufacturing, where uniform product quality is the desired outcome.


It is expected to remain challenging to raise the standard of treatment and lower costs of healthcare due to our current problem-based definition of health and problem-oriented approach to health care. It is suggested that the goal of health care should be to assist each person in achieving four significant goals:

  • Preventing early mortality and disability
  • Maintaining and improving quality of life
  • Fostering personal growth and development
  • Having a decent death

A goal-directed health care system approach would link interventions to substantive results and offer a framework for prioritising. Additionally, it would improve therapeutic alliances, increase adherence to treatment programmes, and lessen defensive medicine’s use and financial burden. Health care would be more efficient, more affordable, and more compassionate as a result.

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