VBC Episode 1: Value means value for patients

In the first episode of our series on Value-Based Care (VBC) we put the "Value" in Value Based Care, but first, what is VBC?

Value based care is a healthcare financial model in which doctors and hospitals are reimbursed not by the services they provide (as they do under the fee for service model) but rather by how well their patients get.

Let's consider a child arriving at the a GP's office with general symptoms such as low-grade fever, runny nose and edgy behaviour. The patient most likely has a cold. The GP can send the patient home with instructions to avoid public places for a couple of days and come back if symptoms get worse.

A different GP could choose to "err on the side of caution" and refer the patient to get blood and other tests done, conduct a mental health assessment and ask to see the patient again in two days and keep going from there.

As a patient, which doctor would you like? If you answered the latter, you might be surprised at just how bad this is, not just for your wallet but also for your health (you can find more information in the attached link at the bottom). Both GPs have actually treated the patient the same way (i.e. did nothing) but one added costs, inconvinienced both parent and child and subjected them to over-diagnosis, that is the risk of finding something to treat that needs not be treated.

In a fee for service model, the first GP will be paid much less than the second. In a value based healthcare model, both GPs will be paid the same. Under this model would you call the "cautious" GP cautious or frivolous? The reimbursement model drives the behaviour of clinicians. Value Based Care encourages them do what the patient actually needs.

If VBC is so much better, then why isn't VBC everywhere already? Find out in the next episode in the series.

Preventing overdiagnosis: how to stop harming the healthy