Web Log


Making the Transition to Value Based Care

5/26/2016 8:42 PM

First, what is value based care and what isn't. Currently we live in a pay-for-play world, much like the Warner Brothers (and the Warner sister, Dot). That means that when you go to the Doctor or the hospital you are charged based on what procedures they perform. The more patients they see, tests they order and procedures they perform, the more money they make.

A value based system measures patient health over time and pays the practitioners accordingly. The healthier the population is, the more money they make. The goal then is to deliver effective care or quality care not volume of care.

The only organizations who currently have any data on which to judge effectiveness of care are the insurance companies. While they have a vested interest in keeping you and yours healthy, and thusly paying out less in claims, they don't. Maybe they aren't smart enough. Maybe they just don't care. Maybe they figure you are the author of your own fate and can keep yourself healthy. Maybe it's just too much work. Whatever the reason is, they simply don't do it.

I guess we need a new type of insurance company (As if you didn't see that coming). Assuming everyone reading this has already read the front page of this site, I am going to explain what we here at Sentia have already done to manage the health of a population..

We have come up with an Individual Health Analysis that is based on bloodwork, physical measurements like blood pressure and heart rate, and lifestyle questions to come up with an individual report that shows the patient what kind of physical condition he or she is in. This data is analyzed instantly by the system and appropriate patient education is prescribed on the spot and is available for the patient to read right on this site.

That doesn't have anything to do with the population though, does it?

This individual data can be rolled up into a Population Health Analysis that details the number of people with any of the tested conditions, any of the answers to the lifestyle questions and any answer in patient history. These Population Health Analyses can be compared year over year to see if a practitioner's population (or a practice or a hospital or a geographic region) is getting healthier or less healthy over time. There is also a Current versus Prior Health Assessment that aggregates the health of individuals against themselves in their own most recent Individual Health Analysis and shows the results side by side. That makes it even easier to gauge the efficacy of a practice.

What should this new insurance company DO with this information (that is currently available, by the way, use the Contact Us page to request a example copies of both)? We should come up with a scheme to reward doctors who are most efficacious based on the number of procedures and the healthiness of the population to reward those who are doing well. Let's call that state 'art with a minimum of steel.' Those who order more tests, perform more procedures and generally try to game the system will have to squeak by on whatever it is we negotiated to pay them, and not a penny more. This new insurance company will not mind making these extra payments either, since it decreases costs of healthcare altogether and makes it more affordable for everyone. We get paid either way, our nominal $10 per month is going to cover the cost of our operation but a healthier United States benefits us all.

All of the things in today's blog are already in place on this site, can be produced in under one second by clicking a button, and being used currently. I know it sounds like an advertisement, but we really are doing things better. We have:

Real Solutions

Date Written Comment By Comment