A recent essay published in JAMA recounts the competing pulls physicians must reconcile while practicing with one foot in the fee-for-service world, and the other in the value-based, accountable care world.

Value-based care models (which intend to reward better patient outcomes and lower spending) are beginning to proliferate the healthcare landscape. Yet fee-for-service purchasing (in which each episode of a patient visit, surgical procedure, hospital stay, etc. has its own individual fee) still remains dominant. This reality commonly leads to temptation among providers and managers to merely incrementally tweak the existing business in efforts to accommodate the change in payment.

Attempting to innovate within the existing business model is only appropriate in cases when sustaining and/or incremental innovations, like a process improvement or upgrade in equipment, are the intended result. In cases of more comprehensive and fundamental changes initiatives, like the shift to value-based care, such a strategy is grossly ineffective. Instead, fundamental change initiatives like this one require an autonomous business unit—separate from the influence of the existing business—to foster growth and success.

For many providers, the switch to delivering care within a value-based system requires a fundamental change in processes and values. As such, the change initiative should ideally be housed in a separate and autonomous business unit.

Read the full article about value-based care by Ryan Marling at Christensen Institute.