Expecting value-based care arrangements can be "win-win" glosses over uncomfortable realities. The result? A lot of meetings and nothing accomplished.
Here are four reasons we hate the phrase "win-win partnership" in value-based care:
What your peers said it would take to get to meaningful risk
As believers in the power of value-based care, we know the win is for the patient—higher quality and lower cost care for the individual – and hopefully, for the population. Acknowledging that every stakeholder's mission places individuals and communities at the heart of what they do, we are all aligned on the win.
But, value-based care is decidedly a move away from an often profitable, broken system and move toward a system that will not reward everyone the same way. Setting the table as if everyone can win glosses over the hard questions: what are you – individual stakeholder—willing to sacrifice to move forward? Or, which combination of wins and losses are acceptable to you and to your partner?
This is true on two levels.
The first is industry level. Value-based care is better for some than others. We all agree we have a cost problem. We all agree we need to solve said cost problem. By definition some folks will lose. To be fair, some benefit more from today's cost problem than others (although no one is totally off the hook). So, less money, means less money and somebody is not going to win.
Two, even if your segment is better positioned, not everyone in the segment is equally positioned. The hope is that those that truly deliver the highest quality and lowest cost care (or make that happen in the easiest fashion) will win. But value-based care isn't cheap—so there is also a layer of size that matters. It's some combination of the best and the right-sized (or at least right-assetted organizations) that will succeed.
One of our favorite pieces on physician partnership highlights this truth well. Plans and providers have a long history in every market. Now, we need them to work together in new ways. For the last ten years of trying to accomplish value-based care, we've largely underestimated the momentum required to get these two groups to work together differently.
Sure, there have been pockets of success, but, if both parties are walking in with the goal of winning, we don't expect the industry to move value-based care very far.
Value-based care isn't easy. It requires change and time to work well. Unless your negotiation is about establishing a vision for the long term, you aren't walking out with a win. You are walking out with a to do list that includes things that will be a win and will be a loss—at least if you are getting creative enough about your value-based care path (as a colleague once said, if all your pilots are a success, you aren't dreaming big enough).
It's easy to say why value-based care won't work and poke holes in tired business tropes. So, what do we do differently?
We stop using the phrase. We stop treating another sector like the enemy. We stop setting ourselves up for failure on what is and isn't achievable in the first year of value-based care contracts when the going is tough but so totally worth it.
We start new conversations. We plan big (and long term). We celebrate the true wins—because they are there. Only then will we actually move the industry forward.
Commercial risk will either tip the industry towards value-based care or keep us in a world of hybrid incentives. It’s complicated, but is it possible? We think so. Learn how you can help push us towards a new cost and quality standard by visiting advisory.com/VBC.
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