Healthcare is broken globally, with health expenditures continuing to grow at an unsustainable and alarming rate without any clear indication that health is improving. As a physician, researcher, and healthcare transformation strategist, I’ve spent much of my time wrestling with a central question: how can we create a healthcare system that truly works for patients and the professionals who care for them?
For me, this journey has been deeply personal, shaped by family dinner table conversations, professional and personal experiences, and an enduring desire to leave a positive impact long after I’m gone. Through it all, I’ve realized that we must reimagine our systems to align incentives to ensure patients – and the outcomes most important to them – are at the center of all we do. When patients do well, we – physicians and the broader healthcare system – should do well. This is value-based health care (VBHC).
Here, I share some of my reflections on the challenges, opportunities, and strategies for building the healthcare system we deserve.
The Problem: A System in Need of Realignment
Healthcare systems worldwide, regardless of their design, face the same fundamental issues. Costs are rising at an unsustainable rate, often outpacing growth in GDP and real wages. Yet, we can’t always answer a simple but critical question: what are we getting from a health standpoint for this money?
Traditional fee-for-service models exacerbate the problem, rewarding providers for doing more—more tests, more procedures—without necessarily delivering better health outcomes. The more you do, the more you get paid. At no point in the current system is payment or “success” determined from the patient’s point of view. Take a common procedure in orthopedic surgery as an example. If you’re undergoing a total knee replacement, your goal is often to increase function, decrease pain, and improve quality of life. But in today’s systems, we rarely – if ever – routinely measure these important outcomes despite having the tools to do so. Unfortunately, success is often measured by metrics like hospital readmissions or mortality rates—important, yes, but far removed from the outcomes that matter most to patients.
The Solution: Moving Toward Value-Based Healthcare
VBHC offers a clear solution: realign incentives so that every part of the system—from physicians to policymakers to insurers—is focused on delivering meaningful patient outcomes that matter most to patients. The shift requires a fundamental redesign of how we measure, reward, and deliver care, but it is not only achievable but essential for the sustainability and resiliency of healthcare delivery systems worldwide. Importantly, it is not a payment model. It is not a cost-cutting exercise. It is a guiding, overarching strategy that leaders can turn to when making critical decisions.
One of the core components of a VBHC transformation that I believe is an important “first step” is routinely collecting and using patient-reported outcome measures (PROMS). These scientifically developed tools go well beyond traditional clinical metrics to capture the patient’s perspective on their health—things like pain, function, and quality of life. PROMs are validated instruments designed to quantify these experiences in a meaningful way, allowing patients and healthcare professionals to have more informed, actionable conversations. It improves shared clinical decision-making.
OvercomingChallenges: The Path to Success
Of course, implementing VBHC is not without its challenges. Thus, while progress has been made in pockets around the world, widespread adoption has yet to occur. However, there are a few areas we can take together to continue this important work:
- Start Small: Change doesn’t happen overnight. Begin by introducing one PROM or piloting a new payment model for a single condition. Success in these smaller initiatives can inspire broader adoption.
- Redesign Incentives: Payment models must reward outcomes, not volume. Well-designed, risk-adjusted bundled payments for specific conditions, for instance, encourage coordinated care that prioritizes the patient’s goals.
- Foster Collaboration: Transforming healthcare requires bringing everyone to the table—providers, payers, policymakers, and, most importantly, patients. When all stakeholders are aligned, change becomes possible.
- Leverage Leadership: Leadership is critical for defining the vision and driving change. Strong leaders inspire trust and create the momentum needed to overcome resistance.
A Vision for the Future
As I look ahead, I’m optimistic about the potential for VBHC to reshape healthcare delivery systems globally. I envision a future where every decision—whether clinical, financial, or policy-driven—is guided by a singular focus on the patient. Importantly, this doesn’t mean reducing physician autonomy or creating a “race to the bottom”, where we simply cut payments. In fact, when patients do better and improve their health, healthcare professionals, hospitals, and the broader system should do even better financially as well. Achieving this vision will require persistence, collaboration, and a willingness to embrace incremental progress to start with the overarching VBHC strategy always as our guide.
One of my core beliefs is that VBHC doesn’t need to happen all at once.Start small, prove what works, and build from there. Each step forward creates momentum, inspiring others to join the movement. When we see the tangible impact of VBHC—better outcomes for patients, greater satisfaction for providers, and more efficient systems—doubts about its feasibility will fade.
