Waymark CEO criticizes health care reform that treats visits like a “loyalty rewards program”

When it involves value-based care, most organizations don’t transcend the bare minimum, health experts at Assets‘s Brainstorm Health conference on Tuesday in Dana Point, California.

While the normal system compensates healthcare providers for every service provided, value-based care focuses more on reducing unnecessary costs and the patient experience, which generally requires greater provider engagement. Value-based care was developed as a substitute for the fee-for-service system, which some experts say is unable to supply quality care to all patients.

Although truly value-based healthcare requires commitment, most organizations’ commitment is “only an inch deep and a mile wide,” says Dr. Sachin Jain, CEO of SCAN Group & Health Plan.

“Some programs are just doing the bare minimum to check a box with the Centers for Medicare & Medicaid Services and aren’t really changing the way they deliver health care,” added Dr. Rajaie Batniji, CEO of Waymark. Waymark provides community-based take care of people on Medicaid advantages.

“Unfortunately, many value-based health care systems function more like loyalty rewards programs than something that could really change the way health care is paid for,” he said.

However, Batniji added that Waymark, for its part, has made progress through machine learning in reducing unnecessary costs, considered one of the important thing tenets of value-based care. A study conducted in January in The nature Scientific reportsfound that the corporate’s Waymark Signal machine learning program achieved 90% accuracy in predicting avoidable emergency room and hospital visits for Medicaid patients, outperforming existing Medicaid risk models.

More changes still have to be made to enhance patient outcomes, Jain said. One possible solution to enhance patient outcomes might be moving from a one-year enrollment period in Medicare health plans to mandatory enrollment periods of three or five years. Because a 12 months is just not long enough to accommodate a couple of annual health visit, some value-based health care providers have little incentive to take a position enough in a patient to get a return later. By moving to longer enrollment periods, value-based health care providers have a greater likelihood of constructing a difference.

“I think people will want to sign up for it because they realize that a health insurance policy that covers your life for three or five years looks at your care very differently than an insurance policy that only covers your life for a single year,” he said.