The Need for Faster and More Furious Change, Ensuring the Impact of Value-based Care and the Coming Age of Consumerism – Belle’s Q&A with Ryan McWaters

Ryan McWaters is a strategic leader with experience building and delivering value-based care services, products, and programs. He is a valued member of Belle’s strategic advisory board. Ryan is a seasoned veteran within the home-based care market while also previously holding leadership positions in strategy and product development for organizations such as PopHealthCare (a GuideWell company), The Advisory Board, and Healthways. Belle recently sat down with Ryan to get his take on a range of issues and trends.

What’s your overall assessment of the U.S. healthcare system as it stands today?

Healthcare continues to lag far behind the rest of society in terms of the experience and outcomes it generates for its customers. We still don’t have true consumerism in the way individuals experience it in every other facet of their lives. There’s a ton of momentum pushing us to get there, including the wave of baby boomers, and the generation following them. The demand for a better experience will just get louder and more intense. At the same time, the population is getting older and sicker. We need seismic change, yet as a system, we continue doing things only slightly differently…so the results and impact are also slight. We’re making incremental improvements and adjustments when what we need is a dramatic shift in our approach. I’d like to be more optimistic, but we’re still just moving so slowly. In areas where we are actually innovating, there’s a lot of talk and not enough action. There’s a lot of buzz and excitement and flurry about “value-based care” but not enough substance and practical application. We need more, faster.

How are we progressing with the adoption of value-based care, and where are we headed?

Over the next few years, we will see models and organizations continue to fail when it comes to value-based care. When it’s time for a lot of the risk-based models to account for their impact and reconcile revenues, many are going to determine it isn’t profitable enough and walk away from it. We’re already seeing that in the market. It’s important for us to have these failures, so we can learn what works and how best to structure value-based care moving forward. I am hopeful from a legislative perspective and an investment perspective that we stay the course with value-based care, but we’ve got to align the payment and incentive models accordingly across payers, providers, and CMS.

Are there specific challenges when it comes to value-based care that you’re seeing in the market?

One of the big challenges with value-based care is that there are so many flavors, and many aren’t really value-based. It’s become a buzzword in healthcare. You have some solutions claiming to be a value-based model when they don’t even physically engage with patients. When you’re working with a high-risk group of patients, and you’re offering is a virtual only solution, that can’t be billed as value-based care. You have to see and touch vulnerable patients. You have to get to know them, their hearts and their minds. There’s no way around that. The mechanics of value-based care, and what it takes to be successful in such a model, require a more intimate level of engagement with patients. Many of the failed models will fall short because they don’t interact at this depth with patients. And on the flip side, we need provider organizations to get adequately reimbursed for prevention activities that don’t necessarily translate to our heavily dominant fee-for-service infrastructure.

What’s one thing that gives you hope for value-based care moving forward?

There are primary care groups emerging that anchor their practices on lifestyle medicine. They are focusing on prevention, treating the whole person, considering the patient’s eating habits, their living environment, behavioral health, and so on. They are addressing all the things that take people down a negative path, and where necessary take the care delivery system to the individual (home, facility, etc). They are tapping into what really motivates patients to drive healthy changes, and makes it easier for them to do so. For me, this is an example of how we change the trajectory of healthcare in this country. If structured properly, value-based care could open the door for this to be the future of how primary care is delivered. That would be a game changer. I believe these practices help paint a clearer picture of how value-based models can be designed for success.

How do you feel about technology’s impact on improving healthcare in recent years?

We have a proliferation of digital tools that simply aren’t working. There are hundreds of solutions all grasping for the attention of high-risk members. From a technology standpoint, we will see leaps and bounds with the application of what AI can do, particularly extending the reach of scarce clinical labor with regards to devices. More than 800 new devices have entered the market in recent years, replacing antiquated tools. These new devices generate information more quickly and more efficiently, helping improve decision making and time-to-treat. I am very excited about what’s next in this space.

What’s an interesting healthcare trend you’re following?

I am watching closely what’s happening with consumer-driven innovation in healthcare. Take GLP-1 drugs as an example. These medications started out being super expensive and exclusive. In response to significant demand, consumer-centric companies have begun creating their own supply chain for these drugs as a way to disrupt the healthcare delivery system and circumvent its bureaucracy. Infusion centers are another interesting example. We’re seeing rapid growth in this area, as these centers take specialty infusion out of the hospital setting. It’s reducing cost dramatically and creating a much better experience for patients. There also a number of independent, value-based health plans emerging on the scene whose rallying cries are all about better experience (members, providers, employers) and better results (patient/provider experience, outcomes, costs). I hope we will see many more examples of this type of shift in the next few years.

Is all of this consumer-driven innovation positive or negative for healthcare in the U.S.?

Overall, it’s positive. However, the first examples we have of this trend are fueled by dissatisfied consumers with the means to do something about it. In the short term, much of these opportunities will remain out of reach for vulnerable populations. We still have a very large subset of our population that is low-income, rural or lacking access, and less health literate. These individuals don’t benefit from bleeding-edge models when they are struggling with basic needs, and most lack the resources to access and take advantage of them. Eventually, the benefits will trickle down, but we need to focus on what we can do for vulnerable populations in the short term. Legislative change needs to move faster than snail’s pace, and we as consumers need to demand much more for our communities and the state of healthcare overall; otherwise, we are faced with continued increasing costs, poor outcomes, and dissatisfied consumers.

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