Value-based care is the antidote to health inequities, intractable costs

Michael Poku: ©Equality Health

In the U.S. health system, various determinants and factors such as income, race, education, gender, sexuality, and even zip code significantly influence our health outcomes. These factors affect how healthy we are, the frequency and severity of illnesses, our access to care, and even our life expectancy.

Consider these stats:

• Non-Hispanic Blacks/African Americans have 2.4 times the infant mortality rate as non-Hispanic whites.
• The most affluent members of society have an average life expectancy 10 to 15 years greater than the poorest.
• The rates for each of the 10 leading causes of death in 2019 were higher in rural than in urban areas.

Health inequities predominantly manifest along lines of race, ethnicity, and socioeconomic status. These inequities stem from underlying disparities in access to healthcare and community resources, influenced by social determinants of health (SDoH) and structural and political determinants. Structural racism, historical trauma, and implicit bias contribute to the inequities, which unnecessarily drive up health care costs and compromise population health.

The National Institutes of Health estimated the economic burden of racial and ethnic health disparities in 2018 at $451 billion. Add to that the $978 billion in costs associated with education-related health disparities. Deloitte actuarial experts project the trajectory of these expenses and predict that spending related to health care inequities could eclipse $1 trillion by 2040.

Beyond the significant human cost, the financial burden of these inequities is simply unsustainable. That’s why it’s imperative that our health care system convert to a value-based care (VBC) model. The traditional fee-for-service (FFS) system rewards the volume of services over quality care and improved health outcomes. It does not consider inequities in health care access or compensate for the impact of identifying and addressing barriers related to social determinants of health, such as housing instability, lack of transportation or food insecurity, all of which affect health. FFS also perpetuates the biases, structural racism and trauma that contribute to health care inequities.

In contrast, VBC acknowledges the pervasiveness of these inequities and addresses them on a personalized, case-by-case basis. It takes a holistic approach to patient care, seeking to get to know the patient before and apart from their illness. This whole-person approach addresses SDoH barriers that might prevent the patient from learning about or accessing the necessary care and works to remove those hurdles. Additionally, VBC also emphasizes proactive and preventive care to improve outcomes and better manage costs.

While VBC is a more equitable and, ultimately, a more financially sound model than FFS, it also requires more coordination and greater involvement among more stakeholder. Providers, health plans, governments, charitable organizations and patients must be collaboratively engaged for VBC to work.

While transitioning to VBC involves all stakeholders in health care, it begins with primary care providers (PCPs). They know their patients best and are in the optimal position to learn more and coordinate care. We are making great progress. PCPs are seeing the benefits of VBC in fewer no-shows, ED visits and hospital stays, as well as improved patient engagement and better outcomes.

PCPs across America must not only survive but thrive. They need help making the transition to VBC, particularly in leveraging technology that can deliver better data collection, analysis and insights at the patient and community levels. Those who work with historically disinvested communities, which often include a disproportionate number of Medicaid recipients, also require support in moving to risk-based value-based payment models.

Providers also need training in recognizing and addressing SDoH, as well as providing care through the lens of cultural humility. Ideally, this will be accomplished in partnership with organizations attuned to community and extended patient needs.

Though it requires upfront investment, collaboration, and a new way of thinking about healthcare, VBC is the solution to close the health inequity gaps and bend the alarming cost trajectory we are on today.

Dr. Michael Poku is Chief Clinical Officer for Equality Health, a value-based care enabler with a Medicaid-first model uniquely equipped to address the needs of diverse and historically underserved populations. Equality Health partners with independent primary care providers (PCPs) delivering people, tech and tools that include risk-based financial support, practice management consulting and community-based clinical supports to help PCPs be successful in VBC.