The healthcare trade is slowly evolving from a fee-for-service mannequin to a value-based healthcare mannequin. However one factor lacking from discussions about value-based care is how it’s measured, stated Don Antonucci, president and CEO of Windfall Well being Plan.

“Some folks say healthcare is value-based, however they solely discuss affordability,” he stated lately in an interview on the AHIP 2024 convention in Las Vegas. “Or they speak a bit about affordability and high quality. However generally they’re lacking. What does entry seem like? Is it the fitting entry along with affordability and high quality? Is there an expertise for the precise medical doctors, nurses and healthcare suppliers? … And the way does that translate to the member or affected person expertise in value-based care? How can value-based care start to handle well being fairness?”

Windfall Well being Plan, headquartered in Portland, Oregon, has roughly 660,000 members. It has plans for employers, Medicare, people and households, and Medicaid. It’s a part of Windfall, a nonprofit well being care system with 51 hospitals.

Antonucci added that a number of industries are shifting quicker than others within the transition to value-based care, comparable to Medicare Benefit. Employer-sponsored plans, nevertheless, progress extra slowly. Though Antonucci is hopeful, this may change.

“We have to see progress – and I feel we’ll – on the employer facet, as a result of a part of what employers are going to expertise is a continued double-digit enhance in advantages. [the cost of] care, and that’s actually not inexpensive,” he stated. “A part of the answer lies in these fashions. That can preserve prices beneath management, but in addition enhance high quality and entry and every thing that employers are speaking about now.”

What offers him a number of optimism in relation to value-based care is that expertise is enhancing to help the shift away from fee-for-service. For instance, Windfall Well being Plan has been in a position to replace its claims system and combine it with its supplier companions, permitting them to share info and supply sufferers with higher care.

Windfall additionally has an app that improves care and makes it extra environment friendly, Antonucci provides. For instance, when he lately made his personal major care go to, the physician was in a position to have a private dialog with Antonucci whereas the data was entered into the digital medical document.

“It truly issues [the doctor] time again and really helps him get entangled,” Antonucci stated. “However what's actually cool is that I can click on on that app, and now the data is served to me. After which any follow-up appointments or issues I’ve are all made there.

Antonucci added that whereas “value-based care will not be the silver bullet answer, it’s a huge a part of the place we have to go to handle the challenges we have now in healthcare.”

Photograph: atibodyphoto, Getty Photos