In the US we have done so well at burying the actual costs of health care. It is surprising private enterprises like LOWE’S and their stakeholders have found a path to value. Outcomes that matter and true costs (=value) are buried under FFS, outcome proxies that mean little to patients (and their providers), inexplicable risk formulas, countless state and federal rules and misrepresented programs that make a purely competitive market out of reach. While not perfect and not right for every market, even the LOWE’S initiative only takes baby steps toward a highly functioning healthcare economy albeit independent of government intervention. Each local scenario will require addressing questions like: Who is best suited to coordinate care and payment? Is it the hospital, a multi-specialty group practice, or another stakeholder, or partnerships thereof? Does it depend on the condition, or procedure? Does it depend on the market?
I predict that value will be the result of local stakeholder innovation among those closest to the health experience. It will be initiatives like this one from LOWE’S driven from private sector business needs and pure competition, actual consumers of care demanding meaningful results (people), those that incur actual costs (people and their employers), and those that actually deliver the health experience that change the system; not cryptic mandates from government and third party payers finding new ways to hide/protect their turf and miss the mark. Our system should take care not to tout payment reform programs as “value-based” when in reality they are not.