Sachin Jain: Rethinking the definition of value-based care

Sachin H. Jain posted the following on LinkedIn:

“I once again debated Rick Gilfillan today on the history and future of the Medicare program in a discussion at the Nautic Partners LLC Healthcare Conference in a discussion moderated by Marshall Votta.

Rick was the founding director of CMMI and one of the most influential people in my career. We agreed more than we disagreed—but had a meaningful discussion as usual on the history of CMMI and the Medicare Advantage program.

Mid-debate it occurred to me that we really need to be more granular in our definition of value-based care. Value=quality/cost isn’t actionable enough or granular enough. It gives organizations too much room to fiddle. Fiddle with the definition of quality. And frankly fiddle with the definition of cost.

So much of ‘value-based care’ has focused on revenue capture and quality measurement optimization—but the quality measurement industrial complex often focuses on what’s easily measurable rather than what’s important.

A proposed revised definition of value-based care:

Intensive outpatient management of preventable conditions and chronic disease to slow disease progression, lower hospitalizations rates, and reduce total costs of care.

What do you like about this proposed definition and what does it miss?”

Sachin H. Jain is the President and CEO of SCAN Group and Health Plan and an Adjunct Professor of Medicine at Stanford University School of Medicine. He also serves as a Board Member at The Paul & Daisy Soros Fellowships for New Americans, an Academic Hospitalist (WOC) at the U.S. Department of Veterans Affairs, and a Board Member at America’s Health Insurance Plans (AHIP). He is also a board member of Omada Health.