I appreciate the time it took you to explain all that. You did a good job.
I am in the opposite camp and don't have the time to write out my position to the extent you did. However, I'd just like to take a moment to point out the ludicrousness of calling something that isn't Fee For Service "Value Based", as if there's anything in the world more "value based" than paying someone for the value rendered in a specific service.
Thanks. I would be interested to hear your perspective.
I agree that "value based care" is probably not the best name for a fully capitated system. (Population health might be closer, but still not perfect.) By definition the "value" of something is whatever someone is willing to pay for it. A doctor's reimbursement rate is negotiated with the insurer, so there is an explicit agreement to pay that rate for that service. And by being a member of that health plan, the patient explicitly agrees to pay whatever deductible or copay is required by the plan, based on the rate the insurer negotiated with the doctor. So in a FFS system everyone has actually agreed to pay the price that is charged.
The problem is that as a patient, it is hard to tell how much a medical service will cost before receiving it. In a grocery store, you can look at the price of milk and decide whether it is worth buying. But there are all sorts of reasons why price consciousness is harder with healthcare (for example: emergency care, lack of price transparency, agency issues). And so the idea of value is harder to measure from the patient's perspective, which is why value and price paid may not exactly match.
I am in the opposite camp and don't have the time to write out my position to the extent you did. However, I'd just like to take a moment to point out the ludicrousness of calling something that isn't Fee For Service "Value Based", as if there's anything in the world more "value based" than paying someone for the value rendered in a specific service.