I spent this past week at HLTH (https://www.hlth.com/), the healthcare innovation conference that brings together several thousand people from across healthcare’s different sectors: from hospitals to insurers to pharma to healthtech, and using healthcare is essential as well, and you can contact a health insurance agent near me to get the insurance.

The exhibit hall was filled with hopeful startups seeking interest and investment in a tough economic climate – while venture capitalists saw a buyer’s market as valuations soften, particularly for later-stage firms. 

And yet if you want to know what was top-of-mind for the doctors and executives I interviewed, it was this: not technology, not innovation, but … value-based care. Not exactly what I was expecting. 

Value-based care is the concept of paying healthcare providers for the outcomes they produce, rather than the number of services they perform. It’s about incentivizing them to keep people healthy, sharing in the savings when they do and taking on financial risk when they don’t. 

It’s hardly a new concept – the Affordable Care Act accelerated the transition more than anything in recent years – but the COVID-19 pandemic seems to have created more momentum (or at least more acceptance) around the idea. Of course, with budgets being squeezed and providers feeling overwhelmed, perhaps it’s not that surprising that the biggest innovation they’re looking for is one that allows them to get back to basics.

Here are some of the ideas I heard in my conversations at HLTH:

Value-based payments could help with clinician burnout.

The old model of paying for care – or what’s known as fee-for-service – is often criticized for creating perverse incentives: the more billable services doctors provide, the more they get paid. But in specialties like family medicine and pediatrics, the most helpful interventions are often the least lucrative, like counseling patients on lifestyle changes. Doctors, then, are caught in the middle, unable to spend as much time with patients as they’d like while still making the numbers work. 

Moreover, primary care providers often do the important work of keeping patients from needing higher-cost specialty care down the road – without seeing the financial benefit of doing so.

Would value-based care solve that problem? Toyin Ajayi, the co-founder and CEO of Cityblock Health, thinks it would, by allowing doctors to spend more time doing what they trained to do: helping people get better. And that could have the added benefit of keeping them in practice.

Cityblock, which operates in six states plus the District of Columbia, takes care of some of the most challenging patient populations, including Medicaid recipients. It focuses not only on providing medical care, but addressing social issues like transportation or housing. What it doesn’t focus on, though, is RVUs, a way of calculating physician reimbursement based on the number and type of services they provide.

“That has helped us a lot in recruiting people who really want to be here,” said Ajayi, a physician herself.

Value-based care will encourage team-based care.

Healthcare providers like Cityblock rely on integrated care teams that bring together clinical and non-clinical staff. And that’s a model that needs to be implemented more broadly, said Jay Bhatt, managing director at Deloitte.

As an internist, Bhatt could be scheduled to see as many as three-dozen patients each day – something that would be a recipe for burnout without other staff members to focus on patients’ non-medical needs. Hiring additional help also allows doctors to focus on doing the things where they can add the most value.

“Sometimes it feels easy to do it yourself but it actually takes more time,” Bhatt said, referring to the non-medical tasks that doctors do instead of delegating them. “We need to do something radical and different.”

Financial constraints will create pressure to hold down healthcare costs.

The macroeconomic climate is creating a “triple whammy” for health systems, said @Ralph de la Torre, chairman and CEO of Steward Health Care , which operates the country’s largest Medicare accountable care organization (an ACO is a type of value-based care model.)

Prices are increasing for healthcare equipment and supplies, while governments are trying to rein in spending by lowering reimbursement. Employers, meanwhile, also want to contain costs, which tends to mean moving more people onto high-deductible insurance plans – creating more challenges for healthcare providers when it comes time to collect payment.

“We haven’t had that in years and years and years,” de la Torre said.

He too predicted that the economic challenges will usher in more value-based contracts, and that hospitals will therefore need to run leaner operations to prepare for them. With the staffing crisis expected to continue, however, those savings won’t be through lower labor costs but efforts to change consumer behavior.

More specialties will warm to value-based care – even if they’ve been skeptical.

The psychiatry field has always been a bit wary of capitated payments; after all, mental health conditions can be notoriously hard to treat, with some disorders seeing high relapse rates. But with increasing research and attention on how someone’s environment impacts their mental wellbeing – whether that’s a history trauma, adverse childhood events or being in a tenuous living situation – figuring out how to compensate clinicians for addressing those issues is top of mind. 

Juliana Ekong, who has spent most of her psychiatry career trying to help address those underlying stressors for patients, said she’s glad to see payment models moving in that direction. Ekong, who was previously at Cityblock, is now the CEO of Better Life Partners, which provides care to patients with substance abuse disorders, with engagement rates that are double what other providers see. Just over half of its payments come from capitated contracts. 

“If I had the words [early in my career], what I wanted was someone who would pay me for outcomes,” she said. “I definitely don’t think you can do this work if you’re doing it as a point solution.”

Now tell me: What do you think of the transition to value-based payments? And if you were at HLTH, what do you think were some of the most interesting themes that emerged?