Zameer Rizvi is CEO and Founder of Odesso, improving patient outcomes through artificial intelligence and machine learning.
Healthcare should be more than just the treatment of symptoms. The goal should be to create positive and lasting outcomes that extend beyond localized care, but the reality for the majority of the population today is that care is only provided when an issue appears and nothing more.
According to the Commonwealth Fund (via CNN Health), healthcare is coming at an increasing cost, especially in the U.S., where we spend the “most on healthcare but [have] the worst health outcomes among high-income countries.”
There’s an opportunity in front of us to change this, but it comes with its own set of challenges and requirements. An approach known as value-based care is slowly coming into the fold and being considered for wide-scale adoption. It’s currently being tested in the U.S. and may be just what is needed to transform the current system.
What Is Value-Based Healthcare?
Value-based care (VBC) is a long-term sophisticated approach that looks at a patient’s full history and considers future outcomes, both positive and negative. This model has the ability to bring great value to patients and puts more accountability on healthcare providers to deliver valuable outcomes more than ever before.
The reason it’s predicted to have a major impact is because the amount healthcare providers earn is directly tied to each patient outcome and considers factors such as quality, equity and the overall cost of care per patient. This means with VBC, providers are rewarded and incentivized to take more accountability in how their patients receive care and also financially encouraged to perform at a higher level.
The Problem
The problem is that many healthcare providers purport that they deliver VBC, but not all healthcare providers claiming to be value-based are truly prioritizing patient outcomes. That brings us to the question: How can you tell if what you’re receiving is truly VBC and not business-as-usual healthcare?
What True Value-Based Care Looks Like
When you think about VBC, a few factors need to be examined closely to ensure healthcare providers are delivering what they say they are. These include improved health outcomes, lower costs and greater accountability in treatment (which can be tracked by assessing the number of appointments, treatment regimens, gained insight the provider is receiving from the patient over time, etc.).
VBC Offers A Long-Term Approach To Care
Healthcare shouldn’t be a series of isolated visits with your doctor; rather, it should be a cohesive approach aimed at keeping you healthy in the long run. In a true VBC system, you should receive much more than treatment for your symptoms. You should receive a coordinated, patient-centered plan that considers your medical history and unique needs. Ideally, an integrated care team would work together to track your health over time, predict potential risks or risk factors and then make better decisions for what you receive or need to do to become truly healthier.
VBC Starts With Understanding A Patient’s History
For VBC to work, clinicians must access a complete view of a patient’s health record, allowing them to collaborate effectively and create strategies focused on preventive care and sustained wellness. One way to do this properly is to use generative AI (GenAI). GenAI is a technology that can support this model by analyzing hundreds of data points in seconds, meaning complex patient history can be turned into insights to help clinicians deliver the precise care each patient needs. Technology, then, can help deliver on the VBC promise, bringing up healthcare quality and aligning every decision with the patient’s long-term well-being.
Warning Signs That Your Care Isn’t Value-Based
Many healthcare providers will falsely advertise that they will provide VBC. Not everyone will be on the same playing field, and certain red flags show that what you’re receiving lacks genuine VBC principles.
The first thing you can look for is if there is fragmented care due to data silos—when different providers store information in separate systems that don’t communicate. With a disconnection like that, doctors will only receive pieces of a patient’s medical history, and you will likely get reactive treatment, addressing symptoms as they arise.
The next warning sign you want to look out for is overly reactive treatment plans. If you’re getting care that doesn’t look or care about your long-term health trajectory, your doctor is probably only addressing your immediate concerns. VBC needs to consider long-term outcomes, not just what’s bothering you today or in the last week.
That brings us to the last red flag to be aware of: a lack of continuity. If you frequently have to change providers that don’t give you comprehensive updates or communicate together, you’re going to receive an uncoordinated approach. That’s falling far short of what VBC should be.
How Generative AI Can Close The Gap
GenAI can be a key factor in bridging the gap between traditional and VBC. It can do what old systems can’t—process extensive patient data and give better insights within seconds that might otherwise go unnoticed. If you’re a clinician and you have a comprehensive view of your patient’s health history, you’ll have data-driven decisions grounded in giving the best advice for your patients’ long-term health. GenAI can do this and actively supports proactive care recommendations.
As an example, if a patient’s history suggests a potential risk for diabetes, GenAI can suggest early interventions to mitigate that risk. AI-driven support for your clinician highlights the most relevant data for each use case. GenAI is a valuable tool to enhance care precision aligned with VBC principles. The cost savings and benefits are valuable for everyone, including patients, private payers, hospitals and physician groups, according to McKinsey & Company.
Healthcare will always remain a core facet of society. It underscores our existence, but as we learn more about the various approaches that can be implemented to optimize the current healthcare system, we must do our part by integrating the necessary changes quickly. We have learned over time that the definition of true healthcare is not merely the treatment of illness and disease.
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