Value-Based Care in High-Acuity Situations

Avoid contracts that apply metrics to situations with high clinical acuities—such as ER, ICU, or Oncology.



Your only way to win in metric-based contracts is to control the costs of the first two standard deviations of patients enough that you can afford the losses generated by the outliers.



In high-acuity situations, EVERYONE is a potential outlier. And each is an outlier in their own individual way. No system will cover enough patients to make the burden it imposes worthwhile.



Humana is trying a “value-based oncology” program.




If at all possible, just say no.




The only way to win that game is not to play.