Questions Linger as Home-Based Care Shifts Toward Value-Based Care

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It would be silly to have an argument over whether value-based care is a good principle. That’s unless, of course, you had to parse out what exactly each individual or organization meant when they referred to value-based care.

No one would argue – or should argue – that making the health care system more focused on providing good outcomes for patients at a lower cost is a bad thing.

But sort of like words that get attached to political culture wars, the term value-based care is now a loaded one. Championing it as a concept – or critiquing it – could put you somewhere in the eyes of others where you don’t want to be.


The home health care industry is moving toward value-based care no matter what its stakeholders believe about the concept. It was a guiding principle behind the Patient-Driven Groupings Model (PDGM), which was implemented in 2020. The Home Health Value-Based Purchasing (HHVBP) Model, soon to be rolled out nationwide, directly refers to it in its name.

In hospice, providers are moving that way as well, due to both external and internal forces. And even in home care, non-medical providers are trying to find ways to be considered value-based care drivers.

“I mean, the term value-based care, it’s just ridiculous,” Thompson Aderinkomi, the co-founder and CEO of the at-home primary care company Nice Healthcare, told me in March. “For all these people in health care to be puffing their chests and saying they’re doing value-based care, it’s just ridiculous. When you go to the grocery store, do you get value-based groceries? Do you buy value-based candles? What we’re doing is just doing good business. And we’re putting the patient first.”


Where Aderinkomi sees value-based care, putting the patient first and doing good business as three separate ideologies, however, others see those three as synonymous.

And while it is true that value-based care is one of the hottest topics in home-based care, the amount of truly value-based care being delivered is still likely relatively low. But that, again, depends on how you define it.

Some have told me it probably represents 5% of all care; some have estimated even lower.

Dr. Sachin Jain, the CEO of SCAN Health Plan, recently penned an article in Forbes explaining his gripes with “value-based care” as well.

I sat down with him recently – along with Home Health Care News sister publication Hospice News – to discuss what exactly bothers him about it, and what the health care system really needs to do in order to put the patient first while maintaining good business practices.

In this week’s exclusive HHCN+ Update, I explore how the home-based care space is grappling with the term, and whether or not the home health care industry is ready for a value-based care overhaul as some seem to think it is.

The ‘religious zeal’ behind value-based care

As someone at the helm of SCAN Health Plan – which is a part of the larger SCAN Group – Jain is intimately familiar with value-based care and its implementation in the health care system at large and in home-based care.

In the aforementioned article that he penned, he brought up multiple reservations about the topic. To name just a few, he wondered openly if value-based care is actually in the patient’s best interest, if it’s too revenue-obsessed, if the touted non-clinical interventions make a difference and if the value-based structure stymies innovation.

As he’s traveled around to conferences and had conversations with people across the industry, he feels that there has been this “religious zeal” formed around value-based care. As someone who was on the ground floor when the concept was popularized, it doesn’t sit right with him.

“I spent the beginning years of my career as a research fellow for Michael Porter, who’s kind of widely known as one of the fathers of the term value-based care,” Jain told us. “And I’ve seen a huge gap between the academic discourse on the topic, and how it’s actually implemented in the real world.”

In addition to helming SCAN’s Medicare Advantage (MA) plan, Jain also was a special advisor to the former Centers for Medicare & Medicaid Services (CMS) Administrator Don Berwick in 2010 and 2011. He helped establish the Center for Medicare & Medicaid Innovation (CMMI), which is responsible for the creation of value-based payment models, including HHVBP.

Value is broadly defined, Jain said, as quality over cost. What he’s seen, because of some of the structural problems with the health system in the U.S., is providers focusing more on the cost side of the equation than the quality.

“That’s not to say that there hasn’t been important progress made in the care of patients through the lens of value-based care,” Jain said. “But what I am saying is that, when things begin to take on a religious zeal, it becomes hard to argue with them. Because people have bought into an ideology almost, that often fails to acknowledge the counter arguments.”

For instance, Jain’s and other critics’ (of which he is not necessarily one) gripes of certain value-based care models include:

– Reducing hospital stays and days in the hospital at all costs can sometimes leave patients and their families feeling “rushed and vulnerable.”

– Specialists are often referred to less, with generalists taking over to decrease unneeded utilization.

– Value-based models are less likely to innovate, particularly when it comes to adopting new, perhaps pricier drugs, “to the point of ignoring higher cost drugs that can meaningfully alleviate patients’ suffering.”

For context, a 2021 report from the Health Care Payment Learning & Action Network (LAN) found that 40.9% of all U.S. health care payments were tied to value-based reimbursement models. These models – which included upside and downside risk arrangements, as well as population-based payments – represented about 238.8 million Americans and over 80% of the covered population.

Though home-based care providers undoubtedly want to move further toward value, many of them haven’t had a real incentive to yet.

Data collection on readmission rates for home care providers is still woefully behind. Home health care providers still experience far better profit from fee-for-service than most other models.

Right now, value – or risk – would most likely come from contracts with payers. Even then, those are somewhat of a rarity. For instance, about 25% of Amedisys’ (Nasdaq: AMED) MA plan partnerships contain upside risk right now based on metrics like hospitalization rates, its CEO, Chris Gerard, said on a Q1 earnings call Thursday.

But in HHVBP, which pits providers against each other, there’s a chance that the chase for value could become intensified. Many of the largest home health providers claim that HHVBP hasn’t changed their way of doing business, but that remains to be seen in practice on a nationwide scale.

“With these changes in payment models and payment systems, there’s always the risk that you’re going to make it harder for people to be human to one another,” Jain said. “And I think that’s something that we have to keep a close eye on.”

A broad brush can’t be taken to suggest all value-based care is good and all fee-for-service care is bad, for instance. Those are simple answers that should be avoided, Jain said.

In the end, I don’t know if I – or Jain, as he admits – have an exact answer to the question I originally posed. Instead, I may have reached another: When the shift to value is reevaluated in three to five years, will it be viewed as a misstep? And if so, to what extent?

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