Who Benefits from the Value Revolution?

It should come as no surprise when we say the U.S. healthcare system is in a state of crisis. In fact, it has been for some time. The pandemic proved that prioritizing volume over value is unsustainable. Together, we have the power to create change. We all know a fee-for-service system is unsustainable, and the time to talk about the problem has come and gone. Our only option now is to march forward toward a more sustainable and effective healthcare system. Those who don’t will fall behind. 

This is our manifesto for change. 

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Who Benefits from the Value Revolution?

THE VALUE REVOLUTION – THE TIME IS NOW  

Healthcare has seen its share of innovations that improved health, increased life expectancy, and led to better quality of life. In 1796, Edward Jenner injected a 13-year-old boy with the cowpox virus and discovered that the boy became immune to smallpox, leading to the world’s first vaccine. Throughout the 1800s we saw advancements and discoveries that included anesthesia for surgery (1846) and the adoption of sterile surgical procedures (1860s). In the late 1800s the first X-ray machine gave doctors a view of bones and organs inside a patient’s body. It also opened the door to other imaging technologies like CT and MRI that give doctors incredible insights and contribute to better treatment plans and preventive care.  

By the early 1900s, researchers discovered antibiotics that could cure bacterial infections. In 1954, U.S. surgeons Dr. Joseph Murray and Dr. David Hume successfully transplanted the first human organ (a kidney) in Boston. Screenings developed in the 1960s and 1970s for cancers – such as mammograms and colonoscopies – gave us new tools to fight deadly diseases. In the early 2000s, physicians at the Mayo Clinic developed and deployed a team-based, interdisciplinary care model. In 2020, the highly effective COVID-19 vaccine was the fastest vaccine ever developed in human history.  

Now there is another critical healthcare revolution underway: the value revolution. We are in the midst of a dramatic change that will enhance well-being, increase life expectancy, and improve patients’ quality of life with better care delivery and payment models. 

WHY THIS MATTERS TO EVERYONE: PAYERS, PROVIDERS, EMPLOYERS 

There are many different players in the U.S. healthcare ecosystem that must work toward a common goal. Fortunately, all the actors in this value revolution – the payers, providers, employers, and patients – have aligned interests.  

As each stakeholder takes the steps necessary to improve care quality, access, and outcomes, cost savings naturally flow from:  

Disease prevention and early disease detection
Proper preventive care is an essential part of overall health and well-being for a population. Unfortunately, only about 8% of adults in the U.S. get all their recommended preventive screenings each year. Missing checkups with a primary care provider or skipping recommended screenings for things like cancer and other conditions can lead to worse health outcomes, lower life expectancy, lost productivity at work, and higher costs to treat conditions as they progress.

Proper care management for chronic conditions 
Treating chronic disease is costly in the U.S. In fact, the Centers for Disease Control and Prevention (CDC) estimates that about 90% of the nation’s $4.1 trillion spent on healthcare in 2020 were for people with chronic and mental health conditions. Better preventive care efforts can help some people avoid developing chronic conditions. Comprehensive care management programs can also help people at higher risk of complications to avoid costly treatment in an emergency room, or unnecessary hospital admissions. 

Appropriate use of healthcare facilities and resources
Value-based care is not about spending the lowest possible dollars to provide the bare minimum care to patients. Instead, the goal is to spend the right dollars, in the right care settings, on the right treatments, at the right times to improve short-term and long-term health. People can avoid high-cost care touchpoints like an emergency room visit, except in true emergency situations when that care is necessary and appropriate.

EVERYONE WINS IN THIS APPROACH – MOST IMPORTANTLY PATIENTS

• When providers are incentivized to focus on appropriate, proactive interventions that improve health rather than driving more volume, patients thrive, and work is more impactful and fulfilling. 
• When payers engage with providers to reward appropriate care, members utilize fewer costly services, and live healthier lives with fewer chronic conditions. 
• When employers have a healthy workforce, they save money on benefits and gain a competitive advantage with increased productivity, retention, and job satisfaction.  
• When a patient’s long-term health becomes the primary focus, they have better experiences, higher satisfaction, and take more accountability in their own health management. 

EVERYONE HAS A ROLE, AND EVERYONE WINS IN THIS REVOLUTION

Payers, providers, and employers all have a role to play in creating a better U.S. healthcare system. But nobody has to do this alone. The value revolution demands the focused attention and action of all of us working collaboratively for a better healthcare future. The tools we need are in place. The interests of all the participants in the healthcare system are aligned. And when we succeed in this revolution, we all win.

Making these changes is not optional, so it’s time to either march forward on this journey or fall behind. Let’s turn the page on healthcare history together.