Value-Based Services: This Is Your Future

This report notes that Anthem’s CEO understands that health plans are now …”moving into a retail world so that our customers…are having to make choices, …and so we have to be responsive.” That’s a notable quote, but what follows is perhaps more important. “We need to build loyalty on a brand they respect. That is retail behavior, not a traditional environment in a (business-to-business) world.” For anyone with a long history in health care, those words are jaw-dropping, but accurate. ‘Health’ plans are experiencing a seismic shift in how they view their customers–and even whom their customers are. Those who purchase benefit plans on behalf of others (employers) aren’t being considered the way they were just several years ago. Plans now understand their real customers are consumers. Providers need to have the same mind-set as well, and this is a big shift in our thinking. A large part of the chiropractic profession has seen plans and networks as their ‘customers,’ altering their business and clinical practices to fit, some notable advances in the profession have resulted. But a lot has been lost, too. As the health industry moves toward ‘value-based purchasing,’ what can we do to position ourselves effectively to benefit, grow, and help people? Actually, quite a bit.

The biggest thing the chiropractic profession can do to enhance its standing, improve the business climate for its members and to increase its own maturity is to focus on developing a way to measure and communicate the value of its approach to health and well-being. Many will argue it’s been doing that for some time, and a lot of data has been gathered that underscore the benefits of chiropractic care.

But the argument here is that we’ve only scratched the surface on what our value is, and that we need to do quite a bit more to improve efforts to more broadly define our value, to communicate it more effectively, and to reach consumers more directly. In the article noted above, Joseph Swedish highlights a very important fact: that the US Department of Health and Human Services expects that by 2018 more than fifty percent of payments in health care will be value-based. Further, the Health Care Transformation Task Force, a private sector alliance of health systems and plans, aims to move 75% of its business into value-based arrangements by 2020 (more here).

What’s ‘value-based’ health care? In general, it’s a model that compensates providers for their outcomes, not the volume of services. This has been taking shape for a number of years, and can be viewed as a success in one way: there’s a lot of data that show that x percent of patients improve by y measures within z treatments. This way of viewing the benefit of chiropractic services has led progressively to the expectation that DCs should get people to feel better in fewer and fewer visits.

These data aren’t wrong, per se, but these efforts to shape the terms of the value of chiropractic services have created a persistent sense that the value of chiropractic is largely based on lessening symptoms. Many will argue with this assertion, but most in practice will understand and appreciate (even if we can’t quantify it with good data) that because of the body’s incredible ability to adjust pain perception before problems resolve that pain and activities of daily living don’t often describe the full clinical picture. Many also argue that focusing on the symptomatic paradigm is the way forward for greater acceptance and utilization, but the trouble with that argument is that it puts us into a medical paradigm where we have lots of well-established competition (largely physical medicine providers and physical therapists) who are very hungry, and whom are already woven deeply into the medical delivery system.

What can doctors of chiropractic do about this now?

  • Work with their state associations to develop and support efforts to more broadly define ‘value’ and the basis for measurement.
  • Develop a sensitivity, tools and efforts to establish a dynamic relationship with consumer/patients to understand what value is in our customers’ own terms–even if they aren’t ours.
  • Request and require EHR/EMR vendors to establish reporting tools that permit individual practices to analyze their own performance.
  • Collaborate on utilization of data clearinghouses and related efforts to aggregate data for greater statistical power.
  • Refine messaging, promotion, advertising, outreach and interdisciplinary relationships to focus on the profession’s ability to deliver on a more nuanced range of value measures.

But perhaps the most important thing an individual provider can do is to begin to think how broadly their practices add value to patients’ lives–because it’s in that understanding that a definition of value must come from, and from that definition ways to measure it. Pain and function certainly matter, but only tell part of the story. It’s up to us to figure out what the whole story is.


Want to read more on value-based health care? Here are some resources:

Value-Based Purchasing: A Definition from the National Business Coalition

Reform Update: Some question the value of value-based purchasing

Hospital Value-Based Purchasing

Making Chiropractic Count in Value-Based Purchasing Initiatives

Outcomes-Based Contracting, The Value-Based Approach for Optimal Health with Chiropractic Services

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