SUMMARY: Value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. In a country where people really don’t care of themselves value-based healthcare won’t work.

Seventy-five percent of Americans have trouble taking their medicine as directed. This lack of adherence is costing many people their good health and the health-care system billions of dollars. Estimates are that approximately 125,000 deaths per year in the United States are due to medication nonadherence and that 33% to 69% of medication-related hospital admissions are due to poor adherence. The total cost estimates for medication nonadherence range from $100 billion to $300 billion every year, when both direct and indirect costs are included. Also, nearly half of all Americans—133 million people—suffer from at least one ongoing or chronic health condition.

Medication adherence can have a more direct impact on patient outcomes than the specific treatment. There are many reasons why people don’t take their medications, including cost and medication side effects but that’s only part of the picture. Americans are not healthy. Less than 3 percent of Americans meet the measurable characteristics that reduce a person’s risks for heart disease, according to new research published in the journal Mayo Clinic Proceedings.

IPoor health is also associated with an increase in cancers. In actual numbers, in 2015, poor diet was associated with over 52,200 colorectal cancer cases; over 14,400 mouth, pharynx and larynx cancers; nearly 3,200 uterine cancers; just over 3,000 cases of breast cancer in postmenopausal women; 2,000 kidney cancers; nearly 1,600 stomach cancers; and 1,000 liver cancers.

The evidence for this is strong. The World Cancer Research Fund estimates that at least 18% of all cancers diagnosed in the US are related to body fatness, physical inactivity, alcohol consumption, and/or poor nutrition, and thus could be prevented.

Then there is health literacy. According to KevinMD.com “we know that health literacy is a significantly underrecognized but major issue affecting the care of patients.  It’s estimated that up to half of adults in the U.S. — 90 million people — have difficulty understanding what their doctor tells them about why they are sick and how to take the medications they are given.  This results in 20% to 30% of prescriptions for chronic medical conditions never being filled, and at least half of these medications not being taken as prescribed. Plus, estimates are that nonadherence leads to up to 10% of hospitalizations and an estimated 125,000 deaths annually. This doesn’t even begin to describe the economic costs associated with limited health literacy.

Value-based healthcare is a good idea whose concept doesn’t match up against the reality of American patients.