By Leemore Dafny, Ph.D. and Namita Seth Mohta, M.D.
NEJM Catalyst, March 2018
Health care stakeholders are not aligned in important goals and in large part are not working together to achieve value-based care, according to the NEJM Catalyst Insights Council. They are waiting on government regulators to change the payment model – including, possibly, single-payer health care.
More than half (58%) of Insights Council survey respondents indicate that their individual organizations are not aligned in working toward achieving value-based care. A higher percentage of clinicians (63%) than clinical leaders (53%) think that payers and providers at their organization are not aligned. At the health care industry level overall, the outlook is even bleaker, with 77% reporting a lack of alignment.
Unlike many industries where the private sector typically takes the lead in driving change, our survey confirms other research that in health care, government payers set the blueprint for private payers to piggyback on. Respondents rate regulatory payment model changes (such as from Centers for Medicare & Medicaid Services) as the most influential among drivers to improve payer-provider collaboration.
Single-Payer Health Care Would Have a Positive Effect on Value-Based Care
Would the ability to provide value-based care get better, worse, or stay the same under single-payer health care?
61% – Better
22% – Worse
16% – Stay the same
Single-payer health care would have a strongly positive impact on the ability to provide value-based care, say Insights Council respondents. This reaction is consistent across all three audience segments of executives, clinical leaders, and clinicians. In verbatim responses, many respondents single out single-payer as the systemic change that would most improve payer-provider collaboration. These results continue the trend that NEJM Catalyst has observed among Insights Council members holding a positive view of single-payer health care.
By Don McCanne, M.D.
In the quest to change from volume to value in health care financing, gimmicky models such as accountable care organizations are being implemented, but the lack of alignment between payers and providers has not achieved the goal of value-based care. This survey of clinicians, clinical leaders and executives reveals that they believe that a single payer approach would have “a strongly positive impact on the ability to provide value-based care.”
Rather than continuing on the path to nowhere laid down by the politicians, bureaucrats, and policy community, doesn’t it seem logical that we should look at the model that those in the trenches – the clinicians, clinical leaders and executives – believe would actually work? Rather than having the payers attempting to align the providers, we should be having the providers who understand the delivery of health care give guidance to the design of the financing system. It becomes ever more evident to those providing the care that instead of a fragmented, dysfunctional market of private payers we should have a single, efficient public payer if we want to inject greater value into our health care system.
It would be infinitely better for the providers to give guidance to the design of the financing system to make it work optimally for patients than it would be to continue to allow the payers to try to design the health care delivery system. That’s how we have ended up with MACRA, MIPS, APMs, ACOs and other screwball ideas. Let’s work on improving the clinics and hospitals instead – under a single payer system. That’s where the value is.
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