Value-based care hit a 'stumbling block': 1 orthopedic surgeon explains why

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Value-based care is a hot topic in orthopedic care, but its lack of consensus among payers, patients and physicians has been an obstacle, Michael Havig, MD, said.

Dr. Havig, an orthopedic surgeon at Naples, Fla.-based OrthoCollier, spoke with Becker's about what value-based care needs to take off.

Note: This conversation was edited for clarity and length.

Becker's Spine Review: How would you describe the state of value-based care in orthopedics?

Dr. Michael Havig: From a physician perspective we always want to take good care of our patients and get them better. In exchange for that, we want to be paid a reasonable fee in a timely fashion without a lot of headaches. I think a lot of physicians think of value-based care as a different way to interact with payers and be rewarded for quality and patient satisfaction. One of the problems we've run into is everybody agrees that lowering costs and improving quality and improving the patient experience are all important. It just seems like people have struggled to figure out how to do that.

So how do you do that? What does it mean to have a value-based care program? 

I think we've kind of hit a stumbling block in that a lot of hospital systems and big incumbent players embrace this concept but I don't really see it being practiced so much on a daily level as a physician. I think the state of value-based care is in a little bit of limbo right now. I think we're still trying to figure it out because the bottom line.

Becker's: So it sounds like not having a full definition of value-based care is the biggest thing healthcare needs to figure out. 

MH: To a payer it means one thing; to a patient maybe it means another, and to a provider maybe it means another thing. It's probably a Venn diagram where they all intersect in the middle. But the question is what is that intersection like? What are the key components of it for a provider, for a patient and for a payer? That's not easy to determine. 

It seems like it would be easy, but it seems like we've had a hard time really deciding what that overlap is. So I think we need to decide what is that overlap between the three parties: patients, payers and providers. Then we have to ask, "What are reasonable goals?" 

I think the reason this confusion exists in part is because we're trying to fit a square peg into a round hole in that we're taking the existing incumbent healthcare system with all the headaches and inefficiencies and saying, "OK, here's this thing over here — value-based care — let's take that and layer it on to this old system or vice versa." I think that's been part of the challenge. 

When you talk about value-based care, you need to break it down into the simpler components of what is a bundle of healthcare? What's that bundle cost? What does that bundle include? Traditionally healthcare has been retrospectively priced. You go see the physician, they do a bunch of things, and they add up the cost of all those things. Let's say it's $1,000 but Medicare pays $150 for that and Blue Cross pays $200. It's just confusing to everybody. I think if an employer or a payer asks, "What's the cost to have an annual checkup?" it doesn't seem like that would be that hard to put a price on. But you really can't find transparent pricing for that 99% of the time. The same thing with specialty care. 

In my case, I'm an orthopedic surgeon. What's the cost for consultation with me? What's included? What's the surgery cost and what's included? If we bundle stuff now we have a product, and if we have a product now, we can put a price on it. Now healthcare can be prospectively priced, and if it's prospectively priced now you can actually have a marketplace for healthcare. That can potentially check the cost side of the equation, and when it comes to value, quality means a lot of different things to a lot of different people too. But the quality can be measured. 

If you know the cost in advance and you can look at quality metrics — even though many of them are imperfect right now — as a patient or a payer, you could say we're going to direct care in this direction. Then as the provider, people are paying you in a timely fashion. If whoever's paying knows the price, and the providers know that the quality is a big piece of that now you can really see true value in healthcare. Ultimately, we can go down that path a little bit.

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