As I’ve traveled around the country, one thing that I’ve learned is that VBR,  (PDF, 121 KB), means different things to different people. Clearly, the transition to VBR is going to result in fundamental changes in how healthcare is reimbursed, how healthcare is delivered and how patients interact with the healthcare system – all of which has tremendous potential implications for each of us because we are all, in one way or another, constituents of the healthcare system.

At HIMSS15, I moderated a diverse panel with four experts—a payer, physician leader, retail pharmacist and hospital CIO—who approach the healthcare ecosystem from very different perspectives. They shared their perspectives on how their world is changing, what value-based reimbursement means to them and how they are approaching this shifting landscape.

The panelists included: Steve Stanic, vice president and chief information officer of Mississippi Baptist Health System; Tim Wright, D. Pharm., president, chief executive officer and co-owner of Wagner Pharmacy Company; Derek Weiss, vice president for Provider Service and Experience for Cigna; and James Whitfill, M.D., chief medical officer for Scottsdale Health Partners, a clinically-integrated network in Phoenix, Arizona.

Steve Stanic reported that in his environment—a major acute-care hospital surrounded by three critical access hospitals—value-based reimbursement has meant an increase in demand to report quality information, not only within his organization but also to his multiple business partners, including payers and providers.

Tim Wright discussed how value-based reimbursement presents retail pharmacies with the opportunity to expand their role and become greater participants in managing their patients’ care. He noted that this is not without challenges, especially in how to efficiently communicate with physicians.

For Derek Weiss from his payer perspective, value-based reimbursement isn’t one-size-fits-all but rather it’s about connecting with physicians and hospitals to find ways to create quality outcomes and incentivizing those outcomes in a way that makes sense in each local market.

As a network physician leader, James Whitfill sees this as a complete 180-degree shift because it’s changing the way doctors have been trained. Rather than just focusing on the patient right in front of them, they now need to think about all the patients in their population; even the one they haven’t even seen yet.

What worries these panelists most about this transition to value-based reimbursement?

  • Lack of interoperability
  • Competition
  • Ensuring that the patient remains front and center
  • Missing this once-in-a-generation opportunity to fix our broken healthcare system

What steps must be taken to be successful in this transition? They offered these:

  • A national patient identifier to facilitate true
  • A focus on
  • Collaboration among all stakeholders to drive connectivity and foster innovation
  • Better tools to support
  • Tools that guide physicians to the most important actionable and analytic insights
  • Alignment of incentives and building trust among all the players: physicians, payers, hospitals, patients and employers

This blog post originally published on the blog in May 2015.

Jonathan Niloff

About the author

Dr. Jonathan Niloff is Vice President and Chief Medical Officer, Population Health, Studiomaca. He was the founder and chief medical officer for MedVentive, which is now a part of Studiomaca. In his current role, he is responsible for the strategic development of population health analytics and solutions. Dr. Niloff has over 25 years of health care experience as a physician, medical director, professor, author and health care technology innovator.

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