A field guide to U.S. healthcare reform: The evolution to value‐based healthcare

• Published in: Laryngoscope investigative otolaryngology 2021-06, Vol.6 (3), p.590-599
• Main Authors: Harrill, Willard C., Melon, David E.
• Format: Article
• Language: English
• Subjects: accountable care; Accountable care organizations; ACO; alternative payment model; Big Data; Childrens health insurance programs; Electronic health records; GDP; Genomes; Gross Domestic Product; Health care policy; Health Maintenance Organizations; Health Policy and Outcomes; Health services; HMO; HMOs; Information technology; managed care; Medicare; P4 medicine; patient‐centered care model; patient‐centered medical home; Pediatrics; personalized medicine; Population; population health; Precision medicine; Principles; Public health; Review; Stakeholders; value‐based healthcare
• ISSN: 2378-8038; 2378-8038
• DOI: 10.1002/lio2.575

Objective A consolidated state‐of‐the‐art review of U.S. healthcare reform efforts that documents the evolution towards value‐based healthcare (VBH) is lacking in peer‐review literature. This field guide attempts to clarify working definitions and conceptual boundaries within the lexicon of U.S. healthcare reform efforts that predated and have common thematic perspectives within the evolving VBH reform paradigm. Data Sources Pubmed/MEDLINE/Google search. Review Methods Pubmed/MEDLINE/Google search was performed during August 1, 2020‐January14, 2021 for U.S. healthcare reform terms, legislative and government agency publications. Those citing relevant legislative, regulatory, philosophical and technological advancements integral to the development and function of VBH were catalogued according to the targeted stakeholders and evolving reform strategy or technology. Conclusions Eight healthcare reform paradigms were identified as influential precursors to VBH: Patient‐Centered Care Model, Patient‐Centered Medical Home, Population Health, Personalized Medicine, P4 Medicine, Precision Medicine, Managed Care, and Accountable Care. Several of these models have similar nomenclature and, confusingly, many have multiple interpretations of the terms used to describe these models. However, consistent stakeholders identified within these paradigms are key to VBH; notably the patient, the physician and the payer (the “Big 3”). Demonstrable healthcare spending reductions have been best achieved when the Big 3 stakeholder interests are aligned within healthcare reform legislation. The definition of “Value” within each reform model was found to be based upon the perspective of the targeted stakeholder. Within VBH, the perspectives of the Big 3 stakeholders form a multidimensional meaning of “Value” that can be represented by the equation Value = Patient Experience Management3. This state‐of‐the‐art review documents the evolution of key healthcare reform models leading to the development of Value‐Based Healthcare reform. Clarifying working definitions and conceptual boundaries of these models will allow physicians to have a greater role in the transition from “volume to value” within VBH model design and implementation