Value-based care has long been healthcare’s white whale.

Since the Affordable Care Act in 2010 mandated outcomes-based Medicaid payment models to cut down on costs and improve care quality, the US healthcare system has struggled to make substantial progress in moving away from the traditional fee-for-service business model.

But with the federal government’s goal to have all Medicare beneficiaries in a value-based arrangement by 2030, health systems are on a bit of a deadline to find solutions.

In a value-based care model, providers and health systems get reimbursed based on the quality of patient outcomes rather than for the number of individual services they provide. It may sound simple on the surface, but in practice, this adjustment requires major structural changes, according to Zahy Abou-Atme, a partner in consulting firm McKinsey’s healthcare systems and services practice.

According to the Center for Healthcare Quality and Payment Reform, there are numerous reasons it’s hard to implement value-based payment systems in healthcare, including the fact that it’s challenging to adequately measure the quality of a clinician’s care and that some value-based payment models can unintentionally reward providers for withholding services.

Keep reading here.—MA

My world’s on fire, how ’bout yours?

In recent years, this has become a common refrain in California, where 95% of the state’s 3,087 hospitals, nursing homes, and mental health in-patient facilities are less than four miles from a “high fire threat zone,” according to a study released in 2023 by the Harvard T.H. Chan School of Public Health.

“There is an urgent need for hospitals and healthcare systems to enhance their preparedness,” Robert Metzke, global head of sustainability at Dutch health tech company Royal Philips, told Healthcare Brew in an email.

Oakland, California-based nonprofit Kaiser Permanente is one of those health systems that’s been directly impacted by wildfires in recent years. Kaiser operates 40 hospitals and 614 facilities across various states—including Hawai‘i, where the system closed its Lahaina Clinic in August 2023 due to wildfires. (It reopened a temporary 5,200-square-foot West Maui space in March 2024.)

As extreme weather events like wildfires become more frequent and intense as a consequence of the climate crisis, Kaiser is putting an emphasis on helping patients in at-risk areas prepare, while also trying to make sure day-to-day operations aren’t greatly disrupted.

Keep reading here.—NO

The country’s big three pharmacy benefit managers (PBMs) are swinging back at the Federal Trade Commission (FTC).

In response to a September lawsuit the agency filed against Caremark, Express Scripts, and Optum Rx—which collectively administer 80% of prescriptions in the US—the PBMs countersued the FTC on November 19 alleging the agency’s suit is “fundamentally unfair” and “unconstitutional.”

The FTC suit claimed the PBMs artificially inflated insulin costs to boost their own profits to the detriment of patients who need the medicine to survive. But according to the PBMs, the FTC’s complaint subverts “accountability and fairness” and attempts to change substantial parts of the pharmaceutical industry.

Keep reading here.—MA