Value-based care is growing rapidly in the real world outside workers’ comp. An excellent session asked if VBC will come to work comp.
Work comp care management today is really fee and utilization management using discounted networks and external vendors.
VBC involves bundled payments and is focused on the patient’s experience and results. Simply put, Value = Quality divided by Cost. That requires evidence based medicine, clinical practice guidelines, measuring outcomes, and monitoring and ensuring use of all these tools.
While VBC is complicated to implement in the real world outside work comp, the additional complexities inherent in work comp make it even more complex. Dr Page noted there are few active VBC initiatives in workers’ comp. While several states appear to support pilots, they are few, far between, and there doesn’t seem to be any results available just yet.
Dr Page sees objective measurement of outcomes – from the patient’s perspective – as key to the adoption of VBC in work comp. She identified a sustained return to work as the desired end point. While that’s true, as we learned yesterday – and undoubtedly you were well aware of this – there are any number of factors driving RTW that have nothing to do with medical care. Employee-employer relations, psycho-social issues, the availability of employment are just three. That being the case, I’m a little skeptical about the utility of RTW as the outcome point.
Other barriers to implementing VBC are
- the need for accurate, consistent, and comprehensive data;
- comfort and trust between the parties (alert!),
- and the inherent complexity of designing payment formulae that consider outliers, risk adjustment, comorbidities, and specific state laws favoring or limiting opportunities to direct patients to use and stay with specific providers.
So, while VBC has a lot of promise, my sense is we aren’t going to see any widespread use for a very long time.
Dr David Deitz noted that one challenge is the lack of ability for or interest among orthopedic surgeons in sharing risk around RTW may be a significant obstacle to surgical bundles.
What does this mean for you?
VBC is an idea whose time has come in the real world, and likely won’t ever come in workers’ comp.