Value-based care has become one of the most misunderstood terms in healthcare, according to Lakshmi Halasyamani, clinical director of Health Effort.
She said hospitals tend to view value-based care as another form of payment — but it’s actually more of a commitment to patients.
“I think we need to evolve on the health system side – move from a contractual relationship to a real promise to the people we care for. And to do that, we need to really understand our populations. We need to understand them clinically and we need to understand how we’re reimbursed. We need to bring those things together so we can create an ecosystem that provides value,” Halasyamani said.
This distinction is more important than ever as part of CMS’s goal to enroll all traditional Medicare beneficiaries in accountable care by 2030, she added.
This goal was set in 2021, but its future is less clear today, as CMS has not yet reaffirmed this goal under its current leadership. Regardless, Halasyamani said the change made sense for Endeavor given its own patient population. The Chicago-based health system’s patient base is older and increasingly requires the kind of coordinated longitudinal care that value-based models are designed to support, she explained.
Instead of creating a separate value-based care division, Endeavor integrated this work into its existing quality and efficiency structures. The idea here was to view value-based care as a lens that should be applied to all patients rather than as a siled program for a subset of them, Halasyamani said.
The goal is to broadly align clinical outcomes with affordability, including for patients who do not benefit from a value-based arrangement at all.
Halasyamani noted that this means considering questions that don’t always appear on a claims form, such as whether a patient can actually afford the treatment they’ve been prescribed.
“If I prescribe a drug for $200 a month, will it be dispensed? And if not, what are my other options?” she said.
Sometimes providers lose sight of the fact that they should tailor a care plan to a patient’s real life, not just their chart, Halasyamani pointed out. That thinking extends beyond prescription costs and extends to other circumstances that determine a patient’s ability to follow medical advice, such as whether a patient’s neighborhood is even safe for walking outside of work hours, she added.
This is the shift in perspective Halasyamani wants to see across the industry: from value-based care as a payment mechanism to value-based care as a true understanding of who a patient is outside of the exam room. To achieve this, she believes health systems will need to invest in data and relationships that go well beyond the traditional medical record.
Ultimately, Halasyamani said the payment structure is secondary to the underlying purpose.
“Our goal should be to create value for everyone, recognizing that payment models may not all be 100% aligned,” she noted.
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