Value-Based Care More Than Just a Cost Savings Play

A recent article in The New Yorker entitled “OverKill” by Atul Gawande describes the harmful effects of unnecessary medical care, with a focus on the resulting adverse medical consequences. It framed the issue of medical waste using a different lens than I typically apply, and I find myself thinking about the implications frequently.

As Mercer’s Chief Actuary for Health and Benefits, I have spent nearly a year leading an internal initiative aimed at understanding how value-based care is changing the health care landscape. Value-based care is a term used to describe a number of strategies for reducing unnecessary care and encouraging the practice of evidence-based medicine by changing incentives for providers and patients. In particular, I’m looking at the implications for the employers with whom we consult. My focus, first and foremost, is on all things financial. Studies point to the large degree of waste in the medical system, and as employers look at ways to flatten the medical trend curve, eliminating waste seems a logical place to start.

I am also a spouse and a parent, though, and will admit to the tiny voice in my head that asks if it were my child or spouse who was ill, wouldn’t I want to exhaust all possibilities to cure them? How do we find the right balance between personal and global interests?

What this article points out, though, is that medical waste is not just a case of better safe than sorry. In many cases unnecessary medical procedures are actually harmful to the patient. Beyond throwing dollars down the drain, we are actually putting health and, in some cases, lives at risk.

As consultants, we continually work with employers to identify cost-effective solutions that improve the health and well-being of their employees and dependents. The value-based care movement has the potential to do just that, by creating financial incentives and accountability within the health care delivery system. These incentives, part of a broad payment reform movement, reward providers for managing cost, improving quality, and increasing patient satisfaction with the health care system.

Many aspects of our current health care system are broken, and it needs transformative change in order to address the fundamental problems that Gawande describes. There are grass-roots movements under way focused on driving this transformation, led by organizations like Catalyst for Payment Reform and National Business Group on Health, and as employers, you can lend your voice to the collective call for action. Wasteful spend for unnecessary tests and procedures not only pressures our profit margins and competitiveness in a global economy, it can harm the people we are looking to help — our employees and their families.

Learn more about value-based care and how you can help to drive this transformation.

Molly Loftus
by Molly Loftus

Chief Actuary, Health & Benefits, Mercer

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