Collaboration key to value-based care's success: Dr. Brian Larkin

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Collaboration, data access and avoiding the "race to the bottom" are all elements important to the future of value-based care, according to Brian Larkin, MD, an orthopedic surgeon and chief medical officer of Denver-based Orthopedic Centers of Colorado.

He told Becker's Spine Review how these factors can help value-based care thrive.

Note: This response was edited for style.

Question: What does the future of value-based care look like?

Dr. Brian Larkin: With rising healthcare costs across the United States, there has been tremendous pressure to consider value-based care as a means to deliver more cost-effective healthcare. Put simply, value-based care seeks to reimburse for the quality of care, rather than the quantity of care as our current fee-for-service model reimburses for.

The Centers for Medicare & Medicaid Services and the Department of Health and Human Services have highlighted this as a priority and have put in place some policies to enact this change. Early examples have included Medicare Shared Savings Program and Accountable Care Organizations. Orthopedic surgeons have started value-based care with bundled payment programs for total joint replacement such as the Comprehensive Care for Joint Replacement and Bundled Payments for Care Improvement. This care delivery model has shown early success and future opportunities. Many stakeholders in commercial- and government-led healthcare are excited about the prospect of further applications.

For value-based care to succeed at a large scale, there must be collaboration among the various stakeholders that are involved in care today. Engagement of both commercial and government payers is essential to build programs for reimbursement that will adequately measure and reward quality care. Engagement of providers is critical as this transition will be massively more successful if the needs and challenges that providers face are met on the front end. Engagement with high-quality provider groups that have invested in value-based care is also important, as many of the lessons these forward-thinking organizations have learned will help guide this transition. Investment in transparent, accessible data is another critical piece as this is how healthcare will show value. Without good data, quality becomes very hard to define. Lastly, but perhaps most importantly, engagement of the patient in this process is crucial. Healthcare delivery in a value-based arrangement may look different to the patient, and we need to explain these differences and help the patient understand how this transition will lead to better delivery of healthcare for them and our community.

Beyond stakeholder engagement, a critical piece in this process is making sure this transition does not cause financial hardship. Healthcare has seen its share of hardship through the current pandemic, and investing in new forms of healthcare delivery requires capital investments and significant time and energy. As these changes occur, we need to reward those who are early adopters and show value, or the adoption of value-based care at a widespread level will struggle. As programs mature and recruit more participants, we must actively look at whether they continue to drive value and adjust accordingly. While the clear goal is to be cost effective, this movement cannot be a race to the bottom, or the success of these initiatives will suffer.

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