Abstract
To address escalating healthcare costs in the USA, many are advocating incorporating a value-based system for healthcare delivery including bundled payments for services. However, this approach brings unintended consequences that could potentially cause new disparities in access and services. Existing health status, or pre-existing conditions, appears to constrain patient access to important, but expensive, treatments, based on measures of quality and inclusion criteria for treatment. While on the surface these decisions appear scientifically sound, the practical solutions available to the obese, diabetic or elderly with multiple chronic comorbidities or socio-economic barriers and limitations who attempt to achieve better health are limited. There may be no single solution, but a serious dialog about ensuring the shift by CMS to a new “value-based payment” model must recognize and address potential unintended consequences. We suggest a new definition of value which includes access as a key component to compensate for this inherent problem.