The Overlooked Frontier Of Value-Based Care: Managing The Rarest, Sickest, And Most Expensive Patients

Could better managing our very sickest patients be the path to lower costs of care? Los Angeles Times via Getty Images

For two decades, value-based care has been built upon a simple premise: if we better manage the sickest patients, total costs of care will fall . This idea catalyzed countless disease-management programs, care-coordination models, and technology innovations. And yet, as the field has matured, an inconvenient reality has emerged. Much of value-based care isn’t truly aimed at the sickest patients.

Instead, the biggest advances have focused on high-volume, moderately expensive chronic diseases: congestive heart failure, diabetes, and chronic obstructive pulmonary disease to name a few. The formula has been straightforward — layer relatively uniform interventions (“peanu