Dr Dennis P. Scanlon on Scaling Value-Based Pilots Across the Country

Dennis P. Scanlon, PhD, professor, Health Policy and Administration, and director, Center for Health Care and Policy Research, Pennsylvania State University, discusses how well the United States health system scales successful pilots in delivering value-based care across the country.

Transcript

When there are successful pilots in delivering value-based care, how well does the United States health system scale these pilots across country?

There have been many pilots in terms of attempting to sort of incorporate value into cared delivery, which of course I would define as better aligning the way care is provided with the payment system. To answer the question, I don’t think we’ve really gotten to scale yet. I think these have remained pilots. I think, probably, the scale that’s happened has happened within organizations and scaling across organizations, so taking programs that they’ve done and branching them out into multiple ambulatory clinics or other acute care hospitals or integrating across their system. I think less so, broadly speaking, across the market or across the country.

You know, that’s not to say that there aren’t some examples. But, I think one of the big barriers frankly, and as was talked about in this meeting is, that we’re still largely in a discounted fee for service-based payment arrangement, so there really isn’t the incentive to scale these things as much as maybe some people had hoped. I think a lot of the organizations that are doing work in this, the delivery systems that are doing work, are ones that are making a bet, forward thinking, that this is the way the payment landscape is really going to go and that its worth going down this path. In fact, I’ve talked to some who have said, “we know what we’re doing is losing money or at least not covering the investment that were making, but we believe that it’s worth kind of getting experience with these programs now, these pilots now, because it will pay off in the future.”

So again, to go back to the question, I don’t think we’ve had nearly the level of scale that was envisioned by CMS, by many others, as we talked about expectations for value-based payment models. It’s sort of that thing that everybody seems to be involved in, but it hasn’t grown quite at the rate that we expected it to be.