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myersj • today at 4:30 PM • 1 reply • view on HN

> There's a paradigm shift needed in how health insurance works: optimize for total cost of care.

Value-based care, e.g. Medicare Advantage.

The idea is that the government gives you $X for the care of a patient, with multipliers on risk factors. The government's goal is for that to be basically exactly what care costs. The provider is incentivized to treat you for less. Which sounds perverse, but if they, for instance, deny all care, a patient will end up in the hospital and cost exponentially more than they would have through proper preventive care. It is not perfect, and it should be broader, but it is a strong optimizer for providing the right care to keep a patient healthy, without providing hundreds of unnecessary tests (and especially imaging) that are medically unnecessary.

It is absolutely a system that should be rolling out to more and more patients.


Replies

nradov • today at 5:44 PM

Value-based care is a good idea in general in terms of better aligning provider incentives with patient best interests and controlling costs. But it doesn't necessarily equate with Medicare Advantage. Many MA health plans still operate largely on a fee-for-service basis with perhaps some minor VBC aspects.