Value-Based Healthcare Models Demand Inclusion And Individuality

07/09/2018 03:47PM

If you’re paid by the test, you’ll conduct more tests. Your business model will be centered around performing tests more efficiently, with various departments perfecting their own specialized tests. There will be billing codes, skills training, and benchmarks marking the milestones toward a higher volume of tests.

This is not a judgment of character, this is simply the result of a system performing according to its own rules. Healthcare providers have spent decades building business models focused on increasing volume. It’s no wonder we have a system that treats a 24-year-old diagnosed with breast cancer the same way it would treat a 50-year-old with the same diagnosis.

The system is built in a way that makes it hard for institutions to see and treat people as individuals. No matter how much an individual doctor or nurse may care for patients as the unique people they are, those same doctors and nurses (and all care providers) still have to function within a system built around billing codes and line items and volume.

But the industry is changing, or at least trying to. A big challenge in healthcare now is how to shift entire enterprises that are organized around that volume-based, fee-for-service model to a model that focuses on value—in other words, one that rewards providers for keeping people healthy. The goals of value-based healthcare are to improve the health of a population and provide a better experience for patients, employees and communities—while managing costs efficiently.

Given these systemic problems, this shift to value-driven care is an enormous challenge.

The Importance Of The Population In Addressing Value-Based Medicine

We can’t talk about improving the health of a population without talking about the population itself. I have discussed population health from a few different angles in the past: how population health offers critical lessons for the future, part 1 and part 2; and how to make population health a brand strategy.

Simply put, in the United States we’re in the midst of a Cultural Demographic Shift that is affecting all industries — especially healthcare, where cultural differences affect how people seek care and where they get their health information. The Cultural Demographic Shift is what happens when large cultural segments of the population reach critical mass or numbers sufficient to have a significant effect on what we do and how we act. According to the U.S. Census Bureau, the United States is projected to become a majority-minority nation for the first time in 2043. While the non-Hispanic white population will remain the largest single group, no group will make up a majority.

But don’t let that future date fool you. The impact is being felt now. According to a report published by the Selig Center for Economic Growth, minority groups are making the fastest gains when it comes to buying power in the United States: since 2000, the buying power of Asian-Americans increased 222%, for Hispanics it increased 181%, for Native Americans it increased 164%, and for African-Americans buying power increased 98%. For comparison, during that same period the buying power of whites increased 79%. Hispanics alone have accounted for nearly half the U.S. population growth since the 2010 census.

Why does any of this matter? Addressing the Cultural Demographic Shift goes hand-in-hand with addressing population health management. In fact, you can’t even begin to bring value to a population of people you don’t even know.

Shift populations do not always feel welcomed by the healthcare industry. They tend to associate doctors with hospitals and hospitals with a place to die, not a place to get better. This is why many first-generation Hispanics would rather have a major surgical procedure performed back in their mother countries than in the United States. Patients want to see people who look like them, can communicate with them, and understand their unique needs (which are influenced by their cultural heritage) when they go to the doctor’s office.

The Importance Of The Individual In Addressing Value-Based Medicine

But, ultimately, healthcare is about the patient in the room. The influence of the Cultural Demographic Shift is telling us that growth strategies are becoming less about the business defining the individual, and more about the individual defining the business.

Returning once again to those challenges mentioned above: how can we change the fact that a 24-year-old with breast cancer gets the same treatment as a 50-year-old, even though they have very little else in common? Or, what if those two patients have different cultural backgrounds that influence how they respond to a diagnosis? The volume approach doesn’t take that into consideration. The value approach should, or it’s really not creating value at all.

Individuality is changing the ways businesses operate. This shouldn’t be surprising. You already experience this in many ways—think of the personalized experience of buying and getting recommendations from Amazon, or requesting a ride-share that shows up within minutes, after showing you a picture of the driver and the car beforehand so you can feel comfortable about the service you are about to use. This is starting to happen in healthcare, as people have more say in how and when they access care and where and from whom they get health and lifestyle information. They can choose a clinic or telehealth over a hospital, and they can find culturally relevant information via online resources like Healthy Hispanic Living.

The key is to get out of the frame of mind that sees diversity and inclusion as an expense and embrace it for what it is: it’s a strategy for growth. It’s an investment strategy that is especially important for healthcare organizations moving toward value-based care. The population changes and the healthcare industry’s response to this cultural diversity is a significant paradigm shift and must be addressed in the core strategy of each industry participant, whether provider, payer or physician.

How else can a healthcare organization really know its populations and why there are gaps in participation or compliance? How else can an organization know how people feel about its services? How else can an organization know how to manage costs in a way that doesn’t diminish the experience for patients, employees or communities?

This isn’t about legal compliance to a diversity standard, which often involves outdated tactical approaches and departments functioning as siloes. This is about transformation. And transformation requires a commitment to inclusive cross-functional and cross-pollinated departments that create an ecosystem that builds upon the required intellectual capital and know-how to better serve individuals within shift populations — and, in turn, better serve everyone.

It really boils down to this: listening to and recognizing people as individuals. It sounds simple, but it requires an act of courage, vulnerability, and wisdom. It demands inclusive leadership.

Unleashing Individuality: The Leadership Skill that Unlocks All Others (2022)