Whereas I’m a training clinician, I’m a agency believer that enhancements in healthcare most frequently come from borrowing the perfect concepts from different enterprise fashions. For instance, I’ve generally borrowed from software program firm and payer colleague insights to explain value-based care (VBC) reimbursement as a subscription mannequin. This mannequin would offer extra constant income and permit organizations to higher climate difficult instances like a pandemic. For suppliers, this might enable freedom from the conduct required to drive fee-for-service (FFS) income and empower an method to affected person engagement that finest addresses their wants. That is very true in relation to investing in social determinants of well being (SDOH), which tends to lag the adoption of VBC.
It’s my perception that organizations looking for to speed up VBC adoption can obtain higher medical outcomes and decrease value by investing in SDOH in a approach much like how hedge funds leverage their portfolios. Hedge funds dedicate most of their assets to their main space of focus however make smaller, strategic investments in different areas that improve their total efficiency.
Making use of this hedge fund philosophy to VBC—directing 20 % of subscription income to the social challenges of 20 % of the affected person inhabitants (Pareto’s precept) that drives probably the most value, looks like a pure match. Offering assist for issues akin to lease, meals, and transportation will do extra to enhance well being and have interaction sufferers proactively than our present mannequin of reactive affected person care – whereas additionally reducing healthcare prices.
I acknowledge wholesome skepticism about this method since any hedge fund fraud makes headlines given the large sums of cash concerned. With that in thoughts, let me present an instance. Think about a healthcare group is in danger for $10 million to take care of a selected inhabitants of sufferers with diabetes. With a hedge fund mentality, that group would take $8 million and apply that to conventional care. The remaining $2 million could be targeted particularly on SDOH by making certain the affected person inhabitants has reasonably priced, wholesome meals delivered to their house every week. This meals supply method will assist handle affected person diabetes in a extra proactive method, in a approach that doesn’t drop a cost, and that funding will produce even better returns in improved outcomes and decreased value and utilization.
An actual-life instance immediately of a corporation that has already begun to undertake this “hedge fund” mentality is ConcertoCare.* Their distinctive, risk-based mannequin of senior care is centered on an method that addresses all aspects of well being and well-being, together with SDOH. When a ConcertoCare affected person is discharged from the hospital, they supply an array of standard touchpoints with the affected person that takes SDOH into consideration – from an in-person go to earlier than the affected person transitions house to make sure they’re arrange for fulfillment to a home-based threat evaluation and extra. ConcertoCare constructed their enterprise from the ground-up with a brand new mannequin of care that prioritizes SDOH and rewards and pays based mostly on affected person outcomes – not the variety of senior sufferers seen day-in and day-out. We’d like extra concentrate on this kind of care and extra funding in SDOH if we wish worth to exchange quantity shifting ahead.
Albert Einstein advised us, “we can not resolve our issues with the identical considering we used once we created them.” It’s vital that we proceed to include finest practices from exterior healthcare with the intention to construct a stronger path to holistic, value-driven care. Making use of a hedge fund mentality to healthcare will assist suppliers and payers steadiness the necessity for assets to spend money on social determinants of well being, whereas additionally rewarding them for embracing the transition to value-based care.
About Dr. Matt Lambert
Dr. Matt Lambert brings greater than 20 years of expertise as a clinician, CMIO, and alter chief in value-based care, making certain that sufferers obtain extra complete care and that payers and suppliers higher seize the worth of their providers. He’s a training, board-certified emergency medication supplier who beforehand based his personal doctor staffing firm and is the chief medical officer at Curation Well being. He’s additionally the writer of two healthcare books: Unrest Insured and Near Change: Views on Change and Healthcare for a Physician, a City, and a Nation.