Value-based care represents a transformative shift in healthcare, prioritizing patient outcomes and cost efficiency over the traditional fee-for-service model. But despite its promise, transitioning to value-based care (VBC) is sometimes perceived as a challenge for providers and their patients.
With that in mind, what is the current state of value-based care in the U.S. and how will medical laboratories specifically fit into this shifting reimbursement model? Danielle Stern, Principal Consultant for Elevated Consulting, which specializes in navigating VBC arrangements, recently sat down with Lighthouse to discuss these complexities and offer insights on how labs could become a vital component within this new landscape.
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Opportunities for Laboratories in Value-Based Care
Though not always the first stakeholder considered in the value-based care ecosystem, laboratories have a critical role to play in the ongoing shift to these new payment models. While Stern acknowledges the exact role labs will play in this shift is yet to be defined, one obvious area for involvement would be assisting with readmission management by detecting early signs of complications or infections post-surgery.
For example, implementing routine post-operative lab testing could identify potential issues before they escalate, helping providers intervene earlier and avoid costly readmissions. This proactive approach not only improves patient outcomes but also aligns perfectly with the goals of value-based care.
“Readmission management is critical in value-based care, and leveraging laboratory insights could help patients stay on track with recovery,” Stern notes.
Furthermore, laboratories could expand their contributions by leveraging diagnostic data to monitor chronic conditions or support preventive care strategies. By offering actionable insights, labs become essential partners in improving overall care quality and reducing costs.
Navigating a Fragmented System
One of the unique challenges of value-based care in the U.S. is patient mobility between health plans and providers. This movement complicates efforts to track outcomes over time and often weakens incentives for health plans to invest in long-term health improvements.
As Stern notes, managing the data required to track patients, particularly those in vulnerable populations, presents significant hurdles. For instance, Medicaid patients often lack stable contact information, making follow-up and coordination even more difficult. Such barriers highlight the need for better systems and tools to manage patient engagement and data continuity.
“This process can certainly feel fragmented—there isn’t always a clear pathway for providers to get involved,” Stern admits. “It’s an area where more streamlined models and further buy-in from the industry are needed.”
Barriers to Adoption: Resistance and Complexity
When asked how she responds to skepticism toward value-based care, Stern highlights a common refrain she hears about the current fee-for-service model: “It’s the way we’ve always done things.” These deeply entrenched systems, coupled with their perceived simplicity, often deter stakeholders from embracing change. From placing a greater priority and focus on annual wellness exams and initiatives for patients to the increased workload for providers, the shift often feels daunting.
For providers, the extended time commitment required for comprehensive wellness exams reduces the number of patients they can see, and concerns about reimbursement remain. Patients, on the other hand, may view these exams as inconvenient or unnecessary if they perceive themselves as healthy.
This inertia is compounded by the complex nature of the healthcare ecosystem. Value-based care necessitates collaboration among health plans, providers, and patients—a process fraught with administrative challenges. Providers must identify patient populations suited for VBC programs, coordinate with health plans, and secure patient agreement for reassignment to new care models.
Another significant hurdle somewhat unique to U.S. Healthcare is that patients often switch insurance providers, which in turn lowers incentives for those payers to track an individual’s health outcomes long-term.
“If a patient switches plans or providers, it disrupts the continuity of care and undermines long-term patient outcome tracking” Stern says. “This instability can create challenges for providers and health plans trying to maintain consistent value-based care metrics.”
Overcoming Challenges and Embracing Growth
Although the path to widespread value-based care adoption is not always linear, providers and healthcare systems must address structural barriers to outcome-based payment models, while stakeholders across the reimbursement continuum—including laboratories—identify new ways to collaborate effectively.
Stern says she believes the opportunities are immense for labs and other providers who are ready to embrace VBC. With a willingness to innovate and a commitment to improve patient outcomes, value-based care can deliver on its promise to reduce costs, bolster our collective health and create a more sustainable healthcare system.
“There’s significant room for growth,” Stern says. “Labs, providers, and health systems will all play a role in improving how value-based care is implemented in the coming years.”
Ready to Learn More?
By staying informed and engaged, labs can continue to help shape the future of healthcare. For more insights into how your laboratory can participate in VBC arrangements, contact Lighthouse Lab Services today.
If you’d like to follow up with Danielle Stern and Elevated Consulting, you may reach out to her at: elevatedcandm@outlook.com or 509-995-6071.