Waymark CEO slams health care reform that treat visits like a ‘loyalty rewards program’


The U.S. health system has often been criticized for putting profits above patients with exorbitant fees and overcomplicated processes that get in the way of keeping people healthy. Value-based care was supposed to fix that, but skewed incentives on the part of some medical providers are getting in the way of changing the delivery of care, according to experts.

When it comes to value-based care, most organizations aren’t going beyond the bare minimum, health experts explained at Fortune’s Brainstorm Health conference in Dana Point, Calif. Tuesday. 

While in the traditional system, health care providers are reimbursed for each service they provide, value-based care focuses more on reducing unnecessary costs and the patient experience, usually requiring more involvement on the part of providers. Value-based care was developed as an alternative to the fee-for-service system, which some experts have said fails to provide quality care for all patients. 

Although true value-based care takes dedication, most organizations’ commitment is “only an inch deep and a mile wide,” said Dr. Sachin Jain, the CEO of SCAN Group & Health Plan.

Some programs are merely doing the minimum to check a box with the Centers for Medicare & Medicaid Services and not really changing the way they deliver care, added Dr. Rajaie Batniji the CEO Waymark, which provides community-based care for people on Medicaid.

“Unfortunately, so much value based care is kind of operating almost like a loyalty rewards program, rather than truly something that can change what’s paid for in health care,” he said.

Yet, Batniji added that for its part Waymark has made progress toward cutting back on unnecessary costs, one of the main tenets of value-based care, through machine learning. A January study in Nature’s Scientific Reports, found that the company’s machine learning program Waymark Signal was 90% accurate in predicting avoidable emergency room and hospital visits for Medicaid patients, outperforming existing Medicaid risk models. 

Other changes still need to be made to improve patient outcomes, said Jain. One possible solution for improving health outcomes could be switching from one year enrollment in Medicare health care plans to mandatory three or five year enrollment periods. Because one year isn’t long enough to do much beyond an annual wellness visit, some value-based care providers have little incentive to invest in a patient enough so that they will later see a return. By switching to longer enrollment periods, value-based health care providers have a better chance of making an impact.

“I think people will want to enroll into 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.

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