Sachin Jain, President and CEO, Board Director at SCAN Health Plan, shared a post on LinkedIn:
“For decades, value-based care has rested on a simple premise:
Manage the sickest patients better and reduce the total cost of care.
And yet, most of the innovation we’ve seen hasn’t actually focused on the sickest patients.
Instead, it’s centered on high-volume, moderately expensive chronic diseases like congestive heart failure, diabetes, and COPD.
These programs – important as they are – tend to ‘peanut-butter’ moderate-intensity interventions across thousands of people. The result? incremental improvements across large populations and modest overall savings.
But here’s a big opportunity we’ve been missing: Better care for patients with ultra-high-cost, low-frequency catastrophic illness.
Think about individuals with advanced neurologic disease, progressive respiratory failure, or complex transplant histories. They may represent less than 1% of a population, yet drive a much larger percentage of total costs.
This is where the next frontier of value-based care may lie. Not in broad, one-size-fits-all disease management. But in radically individualized care models built for the ‘long tail’ of clinical complexity.
This will require: new care operating systems; multidisciplinary specialty models; better home-based support; and payment reform that recognizes extreme acuity and replaces generic protocols with bespoke individualized models.
Done right, this could be clinically and financially transformative.
We often say value-based care should prioritize ‘the sickest of the sick.’ It’s time we actually did.
The next decade will be defined not by how we manage the average patient – but by how we serve the most complex ones.”
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