You were right the first time. Switching to a “value-based” model in 2023 is late and probably only bc gov repercussions. I’ve been out of the industry 10 years, but was doing “value-based” trials at one of Dallas/FTW (Texas, US) largest hospital systems with Medicare, Medicaid, Aetna, BCBS, and other carriers back in 2014. It was a secondary initiative to an Obama era push to modernize healthcare (read put docs on electronic systems) called “Meaningful Use”. Early adopters were rewarded, and by 2015 or 16 were being fined if they weren’t electronic, eprescribing, and interoperable. Before all this doctors made the most money on procedures, and there was no money in treating chronic illness. To reverse that incentive, enter “value-based” blah blah. So United here, after the vertical integration of their own pharmacy (can make up their own prices on meds) and their own doctors (can pay themselves whatever they want for services provided) only Then, did they move to a value-based model. See, only once they were sure they could capture profits elsewhere they aligned with the industry, at least the public payers.

This point is not as evil as using AI to automatically deny claims… But that context should undermine the seemingly altruistic adoption of a “value-based” model. It was a gov mandate from 2008, and they probably got some form of punishment for being so late to adopt.

The payers are the most responsible for high costs in the American healthcare system, full stop. Then for-profit hospitals and urgent cares.