Dr Robert Navarro Discusses Progress in Shift to Value-Based Care

Value-based care can only occur if it is transformative throughout an entire healthcare system or a component of the healthcare system, said Robert Navarro, PharmD, clinical professor, College of Pharmacy, University of Florida.


How much progress do you think has been made in recent years in the shift to value-based care?
First of all, there are many definitions of value. If we ask the patient, the providers, healthcare plans, or the plan sponsors, we can often get a different definition of value. So, there have been many activities in the pursuit of value-based care. Often, they’ve been in very isolated components of the healthcare system, and some of them have been very effective in terms of engaging patients, increasing outcomes, and increasing drug adherence.

From a total healthcare system value-based care model, there’s been relatively slow progression. However, there’s been a lot of activity [of late], and I have great hopes for the future.

What efforts are needed to accelerate this shift?
Value-based care can only occur if this is transformative throughout an entire healthcare system or a component of the healthcare system. For example, if providers pursue a value-based care model based upon CMS reimbursement or bundled reimbursement or quality based payments, they may be very efficient in terms of improving outcomes and meeting some value outcome measurements.

However, if we forget about the patient and don’t engage the patient in many other aspects of value-based care the system may fail even though certain components may be effective. So, I think that we must be very transformative in how we approach healthcare and all of its components, in terms of engagement, making sure the incentives are properly aligned, which is very difficult to do, because when we ask patients, they have a very different perspective of what quality is. Quality, or value, to patients is access to care and affordable care.

The University of Utah study on value recently ranked 8 patient responses of “improving health outcomes.” It was more access and affordability that [patients] considered value, whereas healthcare plan leaders or pharmacy directors of pharmacy benefits may consider best outcomes and cost-effective outcomes when we consider the outcomes divided by the net cost, often used as a calculation of value.
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