The Problem with Referral Search and Decision Support in Value-Based Care Models

In the May 13, 2022, Fierce Healthcare article, “SCAN CEO Sachin Jain: Healthcare should be thinking more about the pitfalls of value-based care,” writer Paige Minemyer shares Dr. Jain’s concerns that healthcare leaders are not having an honest and open dialogue about value-based care.

Dr. Jain has a point. Value-based care is indeed a trend that the industry has gotten behind; after all, who wants to be labeled as against concepts like value, cost-savings and care quality? I like Dr. Jain’s request, for all of us to have honest and open dialog. I’m a fan of the value-based care approach, and I also want to discuss what we can do to improve it at the same time. This is my attempt to move that conversation forward.

I can see why value-based care could feel too restrictive to patients, as narrow networks may reduce choice. Further, I can understand that more choice could improve the patient experience. And, with a caveat or two, I agree.

To bridge the divide, what value-based care (and all care) needs is the capability to support informed choice, and I think this is where the discussion that Jain started was going.

Patients in value-based networks could feel that they don’t have enough of a say in which doctors they can schedule appointments with. But one of the potential unintended consequences of putting the choice fully into the patient’s hands is that the information gathering process is too burdensome. Patients may choose the wrong provider or not do anything at all; we talk about why patients don’t follow up here.

That’s why patients and providers need to work together to decide the next step in a patient’s care journey, leveraging provider search and decision support tools to make the right decision for the patient, the provider and the entire healthcare system. That’s real value.

Now, let’s imagine for a moment that you’re the patient. You and your provider have decided that your next step is to see a cardiologist. Just giving you total freedom here makes it a shot in the dark as to whether you’ll make the exact right next move.

Here’s a simple analogy: Have you ever tried to pick new tile to redo your bathroom? There are entire warehouses dedicated to showing you all the options. What’s more, you could spend hours just answering questions about color, size, material, grout color…sorry, post-traumatic stress issue for me. Anyway, it’s mind blowing and makes the choice overwhelmingly complicated. And that’s healthcare. Actually, you could argue that a tile showroom is more manageable than the healthcare system, but anyway…

Let’s get back to our imaginary scenario. If you had a system with all of the right data to guide your provider search while in the doctor’s office, you and your doctor could identify:

1. The right type of physician based on your need and ensure they had the right equipment and specialty/subspecialty knowledge to perform the task.
2. Which of those physicians are in the network (this network can be defined as preferred (i.e. high quality, low cost) by the health plan, or in the quality network, or part of an ACO)?
3. Which ones are located near you?
4. Who speaks your language?
5. Who is accepting patients?
6. Who has open appointments?
7. Which appointments—at which locations—work for you?

And—it sorts them by proximity (closest to you first, then the rest)

Now you, the patient, are extremely well informed. You now know which physician is best for your situation, who has appointments available, and, you can confer with a trusted resource (your doctor) to help support your decision because you’re still at the office visit.

This is informed choice, provided in a way that’s useful, collaborative, informative and driven by the patient need. This is informed decision-making.

Now all you have to do is pick the appointment time that works for you.

As I recently heard Chef Jose Andres of World Central Kitchen say on CBS Sunday Morning: to change direction (turning left or turning right) can only happen if you’re already moving. So, while we think critically about value-based care, let’s keep moving forward and adjust in real-time. And, as Dr. Jain points out, it’s vitally important that we think critically about the choices that will solve some of the biggest challenges in healthcare.

One thing I think we can all agree on is that simplifying the overly complex process of finding a health care provider and scheduling care would improve the care experience for patients and providers alike. It’s not simply about enabling patient choice—something Jain points out is lacking in some value-based care initiatives—but also supporting informed decision-making in which the patient and provider choose together.

Most everyone I talk with agrees—all of the information to make good care decisions is out there. Now, it’s about bringing that data together—at the right time and in a clearly digestible way—so that it’s easy for the patient to take the next best action to advance his or her wellbeing.