What’s missing in value-based healthcare conversations, says Providence Health Plan CEO

The healthcare industry is slowly moving away from a fee-for-service model toward a value-based care model. But what’s missing from the discussions around value-based care is how it’s measured, says Don Antonucci, president and CEO of Providence Health Plan.

“Some people talk about value-based care and just mean affordability,” he said in a recent interview at the AHIP 2024 conference in Las Vegas. “Or they talk a little bit about affordability and quality. But sometimes they miss what access looks like. Is it the right access in addition to affordability and quality? Is there an experience for the actual doctors, nurses and providers? … And then how does that translate to the member or patient experience with value-based care? How does value-based care start to address health equity?”

Providence Health Plan, based in Portland, Oregon, has about 660,000 members. It offers plans for employers, Medicare, individuals and families, and Medicaid. It is part of Providence, a not-for-profit health system with 51 hospitals.

Antonucci added that certain lines of business, such as Medicare Advantage, are moving faster than others in the transition to value-based healthcare. Employer-sponsored plans, on the other hand, are moving more slowly. But Antonucci is confident that will change.

“We need to see progress on the employer side — and I think we will, because one of the things employers are going to face is continued double-digit cost increases in care, and that’s really not affordable,” he said. “Part of the solution is to move to these models. That will keep costs under control, but also provide quality and access and all the things employers are talking about now.”

What makes him very optimistic about value-based healthcare is the fact that technology is improving and supporting the move away from fee-for-service care. For example, Providence Health Plan has been able to update its billing system and integrate it with its partner providers, helping them share information and provide better care to patients.

Providence also has an app that improves care and makes it more efficient, Antonucci added. For example, when he recently visited his primary care doctor himself, the doctor was able to have a face-to-face conversation with Antonucci while the information was entered into the electronic medical record.

“It actually gives (the doctor) time back and helps them stay engaged,” Antonucci said. “But what’s really cool is I can click on this app and then it shows me the information. And then any follow-up appointments or things that I have are created right there.”

Antonucci added that “while value-based healthcare is not a panacea, it is a big part of what we need to do to address healthcare challenges.”

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