ISPOR: Are Value-based Programs Finishing What Fee-for-Service Couldn't?

Dr. Vivian Lee of Verily Life Sciences believes there have been some really fantastic efforts to move the country to value-based care with great initiatives and pilot projects, however, at this time, we probably haven't seen the full transformation, the full impact of these programs.

Lee, who is president of health platforms at Verily Life Sciences, a healthcare data subsidiary of Alphabet, Google’s parent company, was one of the speakers in the opening plenary session this morning of this year's Professional Society for Health Economics and Outcomes Research (ISPOR) meeting, which is being held virtually. Prior to Verily, she was dean of the medical school and CEO of the University of Utah Health Care in Salt Lake City. Her book, The Long Fix, Solving America’s Health Care Crisis With Strategies That Work for Everyone, was published last year.

Below is a transcript of the interview with Lee. It has been edited for clarity.

Q: In your book The Long Fix you argue that the fundamental flaw of American healthcare is fee-for-service payment and “pay for action” motivates doctors and hospitals to, in effect, overutilize healthcare. Value-based care and payment is supposed to fix many of the problems you discuss, such as incentivizing treatment instead of prevention. Have any of the current crop of value-based programs and models done much to steer U.S. healthcare away from problems of fee for service. Why have they succeeded –or failed? Have they done much beyond affecting the margin?

A: That's a really important question. I tried to draw that distinction in my book a little bit. I know that there have been some really fantastic efforts to move the country to values with really great initiatives, terrific, very interesting pilot projects that came out of the Innovation Center and CMS. So, I want to say that, I really applaud a lot of the effort. But as your question kind of hints, we probably haven't seen the full transformation, the full impact of those programs as much as we would have liked to have seen. A large part that is due to health systems, and and I'm going to call out physicians, particularly among them, have figured out ways to improve quality.

In other cases, maybe to game the system just a little bit, whether it's thinking about how we code different patients. There are all kinds of ways, which is why I think it's so vital that we have tools that we make. A colleague of mine likes to say we need to make the right thing, the easy thing to do. And that's that typically we apply to patients - making the healthier way of living, the easier way of doing it.

I think it also applies to physicians, we need to make the right thing, the easy thing to do for physicians and health systems in terms of how they can deliver on value. So that value isn't just a matter of ticking off some boxes. But value is really kind of a completely different mindset for being evaluated on the outcomes our patients against the costs of the care and ensuring their patient engagement and access to care. So, I think we need to make those tools for everyone to be successful. We need to make tools for for clinicians, for patients, because they are a critical, absolutely critical part of this whole narrative, as we talked about in the whole journey. patients and clinicians need to co-produce, need to work together, and payers as well.

Q: Has the pandemic changed your views of American healthcare, its strengths or its weaknesses? Is perhaps another fundamental flaw the emphasis on healthcare, be it fee-for-service or value-base, and an underinvestment in public health.

A: I'm sure most people feel that conclusion is we've definitely under-invested in public health, there have been a number of studies that have looked at the decline of investment in public health in this country and compared us also with other developed nations around the world. So there's no question that we've been under invested.

It's not just about the investment. It's also about the coordination between public health authorities at the local level, local county level, at the state level, and at the federal level. I think we've seen a lot of that disconnect play out during the pandemic, and the need to create more collaborative models of communication and data and data sharing.

I think those are really important. I think the crisis has further reinforced some of these key principles. For example, it's really critical that people are able to co-produce their own health, outside of the four walls of their hospitals and clinics, that they have the tools to do so. In many cases, digital tools can really accelerate that.

Whether it's sensors and home monitoring devices, or self testing, for example, we saw that with COVID testing, people could just do the swabs themselves. Or enabling them to have the information about what what things that they ate might affect their blood sugar's the most or contribute to their weight gains the most that might be different from other people, everybody's metabolism is a little bit different.

So how do we enable people to manage their own health in a proactive way? That's really an a personalized experience. How do we give the right tools to the clinicians and to the payers, that they can support that so that they will either cover the costs of the telehealth or the sensors and devices that are necessary? Or if they're the case of the clinician, how do they actually work together with the patient in that kind of relationship that's very different from just relying on them coming into the clinic 10 or 20 minutes, six months, every year.

So it does require kind of a change in how we need to think about healthcare and also how we need to pay for health care. But I think if anything, the pandemic has shown that. I called the book The Long Fix because it was written before COVID. Now, I guess I would say, it's definitely going to be a quicker fix it has to be, because I think we all see the urgency of it, whether it's from a public health perspective, or primary care and preventative care and beyond.