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.