Value-Based Virtual Care: Another Solution to the Same Age-Old Problem?

Back in 2020, I was talking with a close friend and colleague, and we were discussing whether the pandemic would speed up value-based care or result in the opposite – retrenching in fee for service. My glass half full perspective hoped that the pandemic was the forcing function we needed. My glass half empty brain believed, more realistically, it may actually result in the opposite.  

I have heard some great stories since then – health plans and providers moving into value-based contracting structures more quickly than ever before to help health systems survive lost FFS revenue and change their business models.  Corewell Health in Michigan, CareFirst BCBS, and others used this opportunity to partner with their providers and define a clear path to value-based reimbursement.  Unfortunately, in many other markets, the reimbursement stop gaps were temporary, and the positive conversations that occurred during the pandemic have reverted back to traditional FFS rate increases and negotiations.  We leapt forward, and then reverted back, possibly even further back than before the pandemic.  Unfortunately the world of value-based care seems to be right where it was before – battling every day to change behavior with small teams of very passionate and motivated people – who are fighting the norm. It’s why I love this small but mighty community. We never give up, and we are always looking for new models to move us just a few steps forward.  

Enter virtual and digital health.  Hundreds of new solutions came to market over the past few years to bring people access – to behavioral health, to chronic care, to primary care,  to navigate, to prescribe medications, the list goes on. Unfortunately, very few of these solutions were set up to deliver value-based care.  These access-only solutions are valuable, but so far they have only added cost to the system. They drove interaction without reducing costs, delivered short-term clinical outcomes without correlated cost savings. I loved being a part of this innovation, but now we need to decide where virtual and digital care fits into the value-based conversation.

We sometimes overcomplicate things in healthcare and forget about the basics.  My favorite quote from the past few years: “If it’s not delivering lower cost, it’s a nice to have.” It’s simple and aligns with the way I hold myself and my peers accountable. It’s how we should hold each other accountable too. Services that aren’t focused on cost are nice, but are only adding to our FFS mindset. More is not better. 

Don’t get me wrong, there is high quality care delivered in FFS models, but the cost is rarely managed. It’s why we have hundreds of solutions to manage chronic diseases, most of which have been proven for years not to work. Yet we maintain them at health plans, health systems, PBMs, and employers. If virtual care is not going to help lower costs, we are all guilty of repeating the same issues and creating the same siloes those of us in value-based care despise. I’m sure many would challenge me and say that fee for service care can reduce costs, but we know in the aggregate that value-based care performs better than FFS, particularly in the senior population.  Countless studies have shown higher quality and lower costs in Medicare Advantage vs. Medicare FFS.  So what is going to be different about virtual and digital care models?  They are continuous and consumer-centric, two characteristics that do not exist in most care delivery models today. 

We are only at the starting line with virtual health models, but there are already incredible examples of solutions providing care for members that aren’t getting the support they need from existing resources.  In these examples, the continuous care model lowers costs for unmanaged members. Now we need to figure out where virtual fits for the broader population. Many of my clients and colleagues are skeptical, and so am I. We should be. This time we need to diligently hold each other accountable for results, just like we would sitting in a room reviewing results of a value-based contract and determining bonus payments. How did we perform, and how can we continuously improve?   

We need to work together — physicians, health plan leaders, hospital operators, digital health innovators, employers, PBMs, pharma — to test and iterate, and quickly, with these new models of care.  The potential is tremendous.