Today a group of community physicians were discussing ACEs (accountable care entities), and exploring their payment structures. Healthcare plans being paid a set amount for taking care of a person within a set population, with incentives to keep them healthy.
Fee-for-value vs fee-for-service. Value vs volume.
What do we mean by value and volume, when it comes to medical care?
Let’s talk asthma.
Volume is treating asthma attacks, one by one–providing lifesaving treatments to the kids who land in the hospitals unable to breathe as their airways clamp down. Saving kids from death to send them home only to see them back in the emergency room again the next week, to repeat the lifesaving treatments, ad infinitum. Volume is paying for infinite treatment for the sick, desperately needed to save lives.
Value is addressing why the kids are getting the asthma attacks in the first place–the moldy homes and toxic dumps and freeways with trucks with idling diesel engines that effect indoor and outdoor air quality. Or the lack of health insurance and difficulty paying for the medications prescribed to keep them well. Value is paying for creating an environment outside the hospital to keep people healthy.
Value is saying “why are people sick, and what can we do to treat that underlying why?”
Value is: community health workers who teach mold cleaning techniques; health lawyers who hold landlords accountable; environmental laws that limit diesel exhaust and place toxic waste dumps far from patients’ back yards; health care legislation that ensures health insurance and affordable medications for everyone.
Sadly, doctors are trained, and have traditionally been paid, to provide volume, not value. Affordable Care Act legislation that encourages population health management forces healthcare systems (medical systems designed to cure the sick and prevent death) to find ways to address the underlying WHYs of disease as a function of the physical and social environment (medical systems that work outside the hospitals and clinics to promote health).
It will be interesting to see how our healthcare system evolves to pay for health care value, instead of sick care volume.