Value-Based Care

Victor JohansonBlog

By John McCartan, Vice President of Innovation, Health Outcomes Sciences, Inc.


For decades, the health care industry evolved at a fairly comfortable pace. Fee-for-service was standard operating procedure. Treatment plans had become fairly diverse. Physician’s treated patients based on training, prior experience and preferences.

Today, health care is a trillion-dollar industry trying to move at an even faster clip. The environment is dynamic. And, with ever more regulation. And, it’s no longer a matter of if providers will abandon fee-for-service, but when.

The industry is grappling with the implementation of value-based care. Payers and providers are trying to figure out how to talk in real-time so they can reduce costs and speed reimbursements. On the payer side, Anthem’s transition to value-based care was recently highlighted.  It is becoming a significant force, even before approvals for its acquisition of Cigna and Humana.

The cardiac team at Barnes Jewish Hospital in St. Louis is facing the challenges with innovation and evidence-based medicine. It has seen clinical and financial gains as they’ve embraced the challenge of value-based care.

When BJH implemented the HOS ePRISM platform in 2013, the goal was to help the cardiac team improve documentation rates for treatment decisions, and to reduce the rate of procedural complications.

Three years later, compliance around documentation is up. All patients are mapped to AUC and designations of “rarely appropriate care” have significantly declined. BJH also documents a significant decrease of post procedural complications and have improved revenue while maximizing bed availability. Overall nursing time and patient length-of-stay also have declined as a result of fewer procedural complications.

Even with these impressive strides, my gut says BJH might tell you that making the change from fee-for-service to value-based care wasn’t always smooth.

After all, we’re asking a heavily regulated industry to abandon previous payment models, to “sunset” treatment methods they’ve used for decades, to move faster and appease vested parties, all while continuing to provide the world’s best health care.

But my gut also says the clinicians at BJH would say evidence-based medicine not only positions them to adopt value-based pressures, but improves provider satisfaction. At the core, the physicians and nurses embrace change when it provides better results and helps patients.