What Would a Do-Over Look Like For The Healthcare Industry?



Ever have the kind of day where you wish you could go back and start over? Press reset so you could avoid the errors you made the first time around? Unfortunately, that is impossible, yet thinking about it can provide some insights out how to move forward and make changes in the real world.

Take the healthcare industry, for example. What would a do-over look like if we had the opportunity to go back in time and make different choices? If one could wipe the current slate clean, how could we build a better, more productive, and efficient healthcare system?

Fee-for-service reimbursement is one stand-out do-over opportunity. People took each step thinking it was the right thing to do. Interventions designed to solve one problem layered on top of other interventions designed to solve other problems, without consideration on how they would impact the system as a whole.

Fee-for-service reimbursement models have resulted in several developments that merit a do-over:

  • “Sick-care” rather than Healthcare- The incentives associated with fee-for-service reimbursement caused our system to ignore people until they were “patients.” No symptoms, no illness, no service. The culture focused on treatment to the near exclusion of prevention.
  • Another artifact of fee-for-service, healthcare delivery fractured into specialized components between which there was little, if any, communication. Higher reimbursements for specialty services meant each patient engagement generated revenue. Each specialist treated their patient in a silo. The problem is that patients aren’t silos.
  • Treating disease, or proactively preventing it, is more of a science. The data proving benefit of treatment fidelity and lack of variation is there. For years, the concept of evidence-based medicine was eschewed by many providers.
  • The development and proliferation of IT systems that can’t communicate with each other.
  • The advent of an adversarial culture between providers and payers rather than one based on cooperation and collaboration.
  • The creation of a system that makes it all but impossible for consumers to identify and compare the cost and/or quality of services provided.
  • Zero incentive for providers to proactively engage with patients around chronic disease treatment and/or management.

Sometimes it seems going back in time is the only way to fix a problem that’s been generations in the making. On the bright side, the advent of outcomes-based reimbursement and value-based models has started to shift this dynamic. Collectively, we are moving towards an improved system based on quality, outcomes, and shared risks.

About the Author

Janet Barros

Janet Barros, Senior Business Development Manager, HealthEdge
Janet Barros is a seasoned healthcare business development executive with extensive sales and client management experience. Janet works closely with senior executives to identify their business objectives and provide the solutions and strategies that enable them to achieve their goals. She has an extensive background in digital health, payer, provider, and solution sectors. Prior to joining HealthEdge in 2018, Janet led successful revenue-generating initiatives at Influence Health, Premier Medical, and, most recently, Aptus Health.

Value-Based Reimbursement: How we got here, what’s working, and who’s doing it well

While the initial investments in value-based reimbursement have, in some cases, made great strides in the march toward quality-based care, costs are still increasing, payers and providers are no closer to a trust-based relationship, and fee-for-service is still a large part of reimbursement. Download the eBook to learn what challenges and opportunities remain on the road to embracing value-based reimbursement.


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