Value-Based Care and COVID-19

Session 2 on the opening day of the 2022 Oncology Clinical Pathways Congress saw speakers discuss “Value-Based Care Solutions in Oncology Pathways.” Mahek A. Shah, MD, MBA, MS, Physician Executive, Investor, Advisor and Managing Partner Harvard University and WTM Advisors; Harvard School of Public Health and Brigham Health, Ariadne Labs, opened the session by speaking on “Value-Based Care: Where We Are After COVID and Where We’re Going.”

“I think the pandemic has really accelerated a lot of the principals that you’ll get a dose of right now, and I think that is going to continue moving forward,” Dr Shah said to open his discussion.

Dr Shah’s presentation focused on revisiting the framework of value-based care and the pathways that benefit from it, looking at recent trends in a post-COVID-19 world, highlighting the companies that have embraced value-based care, and exploring its future both in the United States and worldwide.

This started with an overview of the six segments of the value-based care framework, the first of which is organizing into integrated practice units.

“The first unit is really focused around reorganizing the units within the hospital or health system; we call them integrated practice units,” Dr Shah said. “And effectively, they’re taking what is usually a specialty organization and putting them into what some would refer to as institutes.” He mentioned MD Anderson as a good example of this principle in practice.

The second unit is to measure outcomes and costs for every patient, which has been a problematic area in the past.

“It’s Business 101: what you cannot measure in health care, you cannot manage. Fundamentally, it’s a principle we’ve struggled with as an industry, but we’re getting better at it,” Dr Shah said.

The framework continues with (3) move to bundled payments for care cycles, (4) integrate care delivery across separate facilities, (5) expand excellent services across the geography, and (6) build an enabling information technology platform.

“The fourth, fifth, and sixth are really focused around integrating your facilities, both from a real estate perspective but also geographically,” Dr Shah continued. “Good examples of a geographically well-designed health system, I would say Vanderbilt. Mayo does the same thing in Rochester and Wisconsin.”

Next, Dr Shah highlighted how the increasing number of peer-reviewed publications on the topic of value-based care shows that interest in implementing it in practice is growing.

“Fundamentally, value-based care is a shift in mindset and culture, from standalone confederation of facilities and everyone’s doing their own thing and everyone’s got their own turf, to a clinically integrated delivery system that talks to each other, works together, is incentivized to work together, because the sum is far more powerful and delivers better care than its parts,” Dr Shah concluded.

He then credited Walmart, one of the largest employers in the world, for being committed to this value-based care framework, and he noted that they have been invested for quite some time, partnering with centers of excellence for various conditions.

In addition to Walmart Health, Dr Shah pointed to other companies, both large and small, that are prioritizing value-based care systems—such as Amazon-One Medical, ChenMed, Devoted Health, Spora Health, and Oshi Health.

“Value-based care isn’t only happening at the company level, it’s also happening at the national level. The [United States] is a little slow, but it is moving, and Massachusetts has been one of the stronger states to execute on value-based care,” Dr Shah told the attendees at the Boston-based conference.

In a post-COVID-19 world, there is a focus on IT and workflow optimization, which, Dr Shah said, “needs to be leveraged with AI/ML (artificial intelligence and machine learning) to be updated faster as well as even be created in the first place.”

In addition, post-COVID-19, there is faster acceleration of value-based care. Cost-wise, health systems and employers who were financially affected by the pandemic are much more motivated to move to value-based care.

Dr Shah concluded his presentation with a look at the future. A value-based care culture across organizations is critical to implementation, and it’s crucial to have a physician champion as a voice from the outset.

Ultimately, the field continues to see a push for consolidation and technology-enabled care, and there is a desire among providers to focus more and more on nimble pathways for better risk management and easier adaptation in response to new trials and data.