Finding the path toward fee-for-value

The path toward fee-for-value drives a new connection between the clinical and financial world. Going forward, the financial value of a service will be based more discreetly on the clinical value of the service, and the decision about the delivery of services will be made based on the new metric of volume plus value, instead of just volume. This may seem self-evident, but many organizations have not yet come to terms with the impact of this simple idea. The problem is organizational in nature. Both payer and provider organizations have people who focus on specialized areas as driven by business needs. However, business needs are undergoing a radical shift. The combination of payer and provider functionality through partnership, or through actual integration in the case of health systems owning health plans, is not only necessary, but organizations doing it well will have a significant competitive advantage over those who do not.