The U.S. health system is often criticized for prioritizing profits over patients, with high fees and complex processes that hinder effective healthcare. Value-based care aimed to address these issues, but some experts believe skewed incentives among medical providers are preventing real change.
At Fortune’s Brainstorm Health conference in Dana Point, California, health experts discussed the shortcomings of value-based care. Unlike the traditional system where providers are paid for each service, value-based care focuses on reducing unnecessary costs and improving patient experiences. This system was developed to replace the fee-for-service model, which some experts argue fails to deliver quality care to all patients.
However, true value-based care requires significant commitment. Dr. Sachin Jain, CEO of SCAN Group & Health Plan, noted that most organizations’ dedication to value-based care is “only an inch deep and a mile wide.”
Dr. Rajaie Batniji, CEO of Waymark, added that some programs are just meeting minimum requirements to satisfy the Centers for Medicare & Medicaid Services, without fundamentally changing their care delivery. He likened many value-based care efforts to loyalty rewards programs rather than meaningful reforms in healthcare payment structures.
Despite these criticisms, Batniji highlighted progress at Waymark, which uses machine learning to cut unnecessary costs. A January study in Nature’s Scientific Reports found that Waymark’s program, Waymark Signal, was 90% accurate in predicting avoidable emergency room and hospital visits for Medicaid patients, outperforming existing Medicaid risk models.
To further improve patient outcomes, Dr. Jain suggested extending enrollment periods in Medicare health care plans from one year to three or five years. He argued that longer enrollment periods would give value-based care providers more incentive to invest in patients’ health, leading to better long-term outcomes.
“I think people will want to enroll in it because it’ll be intuitive that a health plan that owns your life for three or five years is going to view your care very differently than a plan that owns it for a single year,” he said.
