Lowering Healthcare Costs

Accelerate Adoption of Value-Based Care

West Health is focused on advancing the adoption of value-based care models among healthcare organizations. Value-based approaches link provider payments to quality and spending outcomes rather than simply the number of services provided.

The Opportunity

The U.S. is stuck in a system of volume-based (fee-for-service) care that continues to drive up costs without providing better outcomes for patients. At a time when so many Americans and employers are looking for new solutions to high prices and poor health outcomes, value-based care can slow the trajectory of costs. Instead of clinicians charging patients and insurers for every appointment, test, or service, value-based payment approaches provide clinicians with more flexibility and accountability to focus on meaningful, cost-effective services to improve their patients’ overall health. Opportunities for success include fewer visits to the doctors’ office, fewer trips to the emergency room, and ultimately the elimination of avoidable hospitalizations.

Our Goal

Real reform entails redefining financial incentives toward reduced costs, greater efficiencies, better health outcomes, and more person-centered care. Adopting value-based models of care would reward positive effects—including preventive care and improved management of diseases and conditions with fewer complications—and discourage unnecessary, low-value and potentially harmful care.

West PACE (Program of All-Inclusive Care for the Elderly)

Established with a grant from the Gary and Mary West Foundation, West PACE in North San Diego County, provides a wide range of health and support services to seniors living with chronic conditions. Participants have access to adult day programs, medical care, social services, dentistry, home care and physical, occupational, and speech therapy. Over 90% of PACE participants are able to remain in their homes and communities, and many live longer, are more socially engaged and have a better quality of life than those in nursing homes or other institutional settings.

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A Roadmap for Value-Based Payment Reform

The Duke-Margolis Center for Health Policy and West Health created state and national roadmaps to provide guidance on implementing value-based payment models through the reduction or elimination of low-value care, improved patient engagement, alignment of payment reforms across multiple providers, and the strengthening of data infrastructure and analytic capabilities. The national roadmap identified four areas where evidence is promising but action has been limited for advancing value-based payment reform in the U.S. healthcare system.

  • Improving opportunities for specialized care payment reforms
  • Transforming serious illness care
  • Reducing and eliminating low-value care
  • Engaging consumers in payment reform

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American Society on Aging’s LeverAGE Podcast: Value-Based Care and Telehealth

Healthcare organizations that had already adopted value-based care models were able to pivot to telehealth more quickly during COVID-19. On an episode of ASA’s LeverAGE Podcast, West Health’s Amy Herr and Michael Kurliand discuss why that’s the case, how the use of virtual care has grown among older patients, what barriers still exist and what healthcare leaders and policymakers should do to remove those barriers and encourage growth in a sustainable way.

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The U.S. healthcare system must accelerate the shift from fee-for-service care to alternative payment models to drive down healthcare costs and improve care quality.

Key to this shift is for major insurers and the Centers for Medicare & Medicaid (CMS) to fast-track development and deployment of effective incentives and policies that facilitate the movement of patients, providers and health systems from fee-for-service payment systems to value-based care models with two-sided risk.

Stakeholders should begin scaling successful models with enough flexibility so they can be adapted across communities and healthcare settings.

Lowering Healthcare Costs News


Medicare also has precedent on its side regarding coverage of other medical products developed for Alzheimer’s patients. Aduhelm isn’t the first medical product associated with Alzheimer’s disease that has been subject to a CED, said Sean Dickson, director of health policy at the West Health Policy Center.
Around 112 million Americans have trouble paying for health care, while more than 90 percent of the country believes it is not worth the cost. The data was collected by Gallup and West Health through the Healthcare Affordability Index and Healthcare Value Index
Aduhelm’s price drop in December was a windfall for providers in the first quarter of this year because Medicare was still reimbursing them the previous price plus the add-on payment, according to Sean Dickson, director of health policy for West Health.
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