Few would dispute that modern film and television is dominated by Marvel's comic book stories. But would you believe that it also provides health care with a unique lens for understanding global progress towards value-based care (VBC)?

Blog post: Back to basics on VBC

As a long-time comic book fan, we are entering into my favorite form of the genre's storytelling: the alternate universe format. When done well, the 'multiverse' lets us see the outcomes of different choices and actions.

But what does that have to do with VBC?

My colleagues persuasively argue that there are many flavors and definitions to VBC. And when you look around the world, there are different ways that the idea of value-based health care is taking shape. Essentially a world view gives us a "multiverse" of options to see how VBC plays out.

The 2 words that get us in the most trouble with VBC

Here are the major ones we're tracking:

1. Government pushes network assembly first
   • Places where it's happening: England and Ontario, Canada
   • Characterized by voluntary assembly of provider organizations that serve a geography
   • Struggled to wrap in primary care practices which are independent, entrepreneurial entities
   • Allocated significant time to governance and reporting requirements
   • Very little headway on incentives or payment changes
2. Providers lobby the commercial payer for incentives first
   • Places where it's happening: certain Latin American countries
   • Characterized by hospital operators approaching commercial payers to construct contracts that would reward outcomes
   • Struggled to garner wide adoption
   • Appeared to make some headway on bundling payments for predictable elective care like orthopedics
3. Government eases into incentives first
   • Places where it's happening: US' voluntary medicare shared savings programs
   • Characterized by voluntary participation, requiring a primary care partner, and easing into downside risk
   • Struggled to garner wider adoption and consistent financial savings
   • Appeared to be most successful when led by physicians and found savings through diversion from inpatient care
4. Build the data infrastructure first
   • Places where it's happening: United Arab Emirates
   • Characterized by a push towards a unified dataset to coordinate providers and intervene on care earlier
   • Still in its early stages but applies to both public and private providers
   • Possible because of stronger governmental controls and management of health care

What I'm watching

At the risk of chasing the shiny and new, I am curious to see how the UAE's approach to using connected data shakes out. We often talk about how a source of truth can be critical to getting everyone on the same page (and VBC is a cooperation problem as much as it is an incentive or care model problem). And we're a sector that puts a lot of weight on data and evidence. My hope is that in this VBC multiverse we measure how far, fast, and critical sharing data across the continuum is.

It's hard to move VBC forward when nobody understands what you mean

I'd encourage everyone to pull up from their local context to track value-based care globally. I'm willing to bet that all versions of VBC are going to accelerate in the next two years for two reasons:

1. With the rising cost of everything, affordability is going to be a key priority for health care.
2. Covid-19 has made the case for decoupling health care from the hospital more eloquently than any research or policy

I'll be sure to circle back and share the state of play in these markets in 6 months.