Value-Based Care is 3.0

Valuebasedcare is 3.0 and DirectPrimaryCare is 2.0 an expert in primary care models told me Tuesday over fish tacos.

Here’s why he’s wrong:

  • VBC relies on the kindness of BUCAH.
  • Yet they are directly competing for PCPs.
  • So can set the amount they pay below realistic economics to drive VBC ACOs to their knees.
  • Like they did with dozens of services like independent imaging or orthopids or DME.
  • They will do the same to independentACOs married to VBC in primarycare then “rescue” them. Buy em cheap. They can later pay themselves a fair rate. A fat profit, in fact, because it’s not their money. It’s ours.

DPC is more resilient to this game largely opting off the tilted game board.

Why would they do this if VBCs offer great value? Because they can.

Call me a jerk, but VBC appears a race to the bottom until BUCAH owns it all. It’s so clear.


“We can get typecast as anti-insurance or anti-government,” Umbehr said but likes the idea of insurance used appropriately.

“Insurance is perfect for expensive things, hospitalizations, major car wrecks, your house catches on fire, but … you don’t submit an insurance claim to wash your car, to paint a new room in your house, [or get] an oil change. … Insurance is a great tool, but not for affordable things,”

When Death Spirals Occur

Death spirals occur when younger, healthier members abandon private health insurers and leave behind costly, chronic, older members. The healthy jump ship exponentially over time and that’s happening in Australia today. It’s a cautionary tale for BUCAH — a worst nightmare for their CSuite.

Not sure we have all the signs below but enough of them to pay attention. They too have a dual system. Federal is outgrowing private. And the young there are functionally uninsured with deductibles they simply can’t afford.

2019 will be remembered as a tipping point:

◾️Over half don’t have liquidity equal to their deductibles So no ladder to the treehouse of care. Forget homeownership. The Dream. The Promise. Dead.
◾️Health costs (48%)almost equal the rest of the federal budget.

Addressing the National Press Club on Wednesday, Duckett succinctly summarized his findings: “When we looked at the private health insurance industry, we found an industry ◾️strangled by red tape, ◾️riddled with perverse incentives, ◾️suffering learned helplessness, ◾️turning to government to fix all its problems, and labeled by the regulator as ◾️complacent.”