How Healthcare is Changing . . . and What It Will Mean For Us (Part II)

About eighteen months ago, on 27 June 2022, the Dubai Health Authority’s (DHA’s) Health Insurance Corporation hosted an event to celebrate the launch of EJADAH, a first-of-its-kind healthcare model for the Emirate.  It was, in short, an introduction to and pilot of value-based care right here in the UAE. 

We left last week’s blog with the question, ‘What exactly is value-based care, and how might its principles reshape the future of healthcare not only in the United States but on a global scale?’   Let’s dive into that now because value-based care is getting up close and personal here in the UAE.  Truly, it just might change everything for us.

Let me start this post with a reminder of what I believe is one of the most significant characteristics of value-based care:  it’s financial model.   Value-based care offers quite a radical departure from the traditional fee-for-service model used both here in the UAE and in the US.   Fee-for-service programmes rely heavily on physicians and medical centres to discipline themselves when it comes to recommending other ‘services,’ e.g.,  lab tests, screenings, or procedures.  Doctors are supposed to suggest those extra services only when there is demonstrable need but when it comes to labs, for example, more labs can provide more insight and of course more insight is almost always better - especially if the clinic also gets a cut.  Right? 

Maybe.  Sadly, our traditional fee-for-service model seems to encourage expenditures that have very little to do with need and a lot more with extra money.   It’s a system that motivates quantity over quality.  Clearly, under a scheme like this, your visit with the doctor will be short.  S/he and the clinic can increase their pay only if they increase the number of patient visits each day.  So, necessarily, visits will, and have, gotten shorter and shorter.  Efficiency is good, but it’s tough to explain how you feel when you have a complicated chronic illness.  Five minutes doesn’t usually cut it.   In truth, the average doctor visit now barely allows for more than basic information exchange and presentation of a prescription.

Value-based care, on the other hand, seeks to align healthcare incentives with patient well-being. In this model, healthcare providers are rewarded for delivering high-quality care that both improves patient outcomes and lowers costs.

How? 

Again, the secret is in the financial motivation provided.  Under value-based care, clinics and doctors generally work with what is called a capitation model.  Under this payment arrangement,  healthcare providers receive a fixed, per-person (or per-member) payment from a payer (e.g., government health programme, employer, or insurance company) for the entire spectrum of a patient's healthcare needs over a specific period.   The fact there is a fixed payment encourages healthcare providers to deliver cost-effective and high-quality care to keep patients healthy and prevent unnecessary medical interventions. The emphasis is very much on preventive measures and holistic care that will keep everyone as healthy as possible.   Of course, preventing heart disease by teaching people to eat well and exercise appropriately is alot cheaper than most triple by-passes. 

So, again, under value-based care, healthcare providers are encouraged to focus on preventive measures, early interventions, and holistic approaches to patient care.  The intent is to address health issues before they escalate and require expensive treatment or hospitalisation.   Importantly, under this plan, patients often play a more active role in their healthcare journey. When individuals are empowered with the tools and information needed to build healthier lifestyles for themselves, there is significantly increased likelihood of improved and sustainable wellness for the patient over the long-term.

Of course, value-based care programmes also require quite intensive measurement.  Under this sytem, healthcare providers are accountable for the outcomes of their interventions. Metrics such as patient satisfaction, readmission rates, and overall health improvement are used to evaluate the effectiveness of care delivery.  The system is all very tech-heavy.  For example, the adoption of electronic health records (EHRs) has proven to be essential in tracking and analysing these metrics. EHRs facilitate seamless communication among healthcare providers, ensuring that patient information is readily available and that care is coordinated across various specialties.

Hopefully, value-based care will also increase collaboration and care coordination among healthcare providers. Instead of operating in silos, specialists, primary care physicians, and other healthcare professionals should work together to provide integrated and comprehensive care, ensuring that patients receive the right care at the right time from the right provider.

Finally, value-based care services should extend out into our communities.  Again, there should be real incentive for medical organisations to forge partnerships with community organisations, social services, and health coaching programmes not only to address the broader determinants of health but also to create a richer, sustained support system for patients.  Research has demonstrated that factors such as socio-economic status, housing, and access to education impact an individual's health. Similarly, there is increasing evidence that providing coaching and encouragement increases the likelihood of improved lifestyle.  So, if healthcare providers want to keep their expenses low, they’ll start working to get truly involved and influential in our every day lives.   

Potentially one interesting way they’ll do that is with telehealth services.  Telehealth services have witnessed a surge in adoption, enabling patients to connect with healthcare providers virtually. This not only increases convenience for both the patient and provider but also allows for more frequent and personalised interactions, fostering a stronger patient-provider relationship.

So, if we do indeed see value-based care expand here in the UAE and around the world, we should be expecting to see healthcare recreate itself as a community-based, lifestyle-oriented initiative.  I hope we might see the majority of the population working with health coaches who can mentor them through the behavioural changes that will ensure improved sleep, diet, stress management, and movement.  Perhaps we’ll also see more folks gardening, more people cooking together, socialising together, and investing in community activities.  I hope businesses will also become more active in encouraging employee wellness.  Perhaps they’ll invest more in employee sporting events, daily meditations, and encouraging people to take walks while they are meeting.   Perhaps they’ll invest more in the quality of the food served in their lunchrooms!

Wow, life could be good.

But of course, while the transition to value-based care holds immense promise, it is not without challenges. Healthcare organisations face the task of adapting their infrastructure, workflows, and culture to align with this new paradigm.  The shift from a volume-driven approach to one centered on value also requires significant investments in technology, training, and organisational change.

Payers, too, must adjust their reimbursement models to motivate quality outcomes. This necessitates a collaborative effort between payers, providers, and regulatory bodies to establish a framework that promotes value-based care.

There is a long way to go before the true promise of value-based care is realised. But value-based care makes so much sense:  it offers less expensive, high quality care that actually keeps us well. Employers would like it. That seems clear.  But, of course, there is a great deal of vested interest in the status quo. 

This movement towards value-based care marks a pivotal moment in the evolution of global healthcare. By embracing a patient-centric philosophy, leveraging technology, and fostering collaboration, the system promises to yield better outcomes, lower costs, and a more satisfying patient experience in the years to come.

Perhaps the UAE can make it real.