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Value-Based Care as Integrated Care
Those are promising signs. On the other hand, the fundamental economics of the value-based arrangement still aren’t clear. If fee-for-service turns out to more profitable for both payer and provider, then value-based care won’t survive outside of Medicare Advantage. And there have been failures in the past, as cited above.
Steve Hardgrove • The Disruptors, Part 1: DTC Insurance
In the value-based scenario, scale is not nearly as important as in fee for service. While it still helps in some ways (e.g. for investing in tech platforms), it’s no longer the primary basis of competition. So in shifting to a value-based arrangement, much of the incumbents’ advantage is reduced.
Steve Hardgrove • The Disruptors, Part 1: DTC Insurance
The bullish story here is that a new opportunity has emerged, especially in the Medicare Advantage market, for a new business model that serves patients better. It uses an integrated approach with value-based incentives in order to enable a better customer experience, and to save on costs by preventing hospitalizations.
Steve Hardgrove • The Disruptors, Part 1: DTC Insurance
Entrenched interests are tough to navigate, but I would say that this crisis is forcing every line item and service provider to be scrutinized and see exactly what they’re providing. Right now, every buyer in healthcare is trying figure out how their different healthcare service providers can help them in a remote-first way, and most of these compa... See more
Nikhil Krishnan • “There Are Too Many Entrenched Interests”
Under value-based care, payers win financially when their members are engaged and receiving the right care, because that’s how they both drive membership AND limit costs. Patients are the winners.
Steve Hardgrove • The Disruptors, Part 1: DTC Insurance
There is a lot of talk in the healthcare world lately about “value-based care.” This means that instead of being paid for each individual test, procedure, or office visit, health care providers are increasingly being reimbursed based on how well they improve patient outcomes. In other words, providers are being paid to keep people healthy, rather t... See more