Running the Healthcare Gauntlet: Lost, Found, and Laughing All the Way to Value-Based Care: Part I

Even Canva is stressed over the Healthcare Gauntlet and left out the T

Tracing Roots of Value-Based Care, Methodology, and Rankings… Before the ACA

Imagine, you are running in a race with no clear markings, aid stations that might or might not exist, and a finish line rumored to be somewhere ahead, but only those in first place will ever see it. The starting gun apparently went off, but nobody remembers exactly when, and some folks are still stretching, completely unaware the race started. And yet, here we all are: still running, still questioning, and still cracking jokes to hide the fact that we’re all just trying to do our best.

Long before “Value-Based Care” became the buzzword echoing through every healthcare boardroom, the race rules were simpler: more services meant more reimbursement. Remember an era (if you can) when paper charts ruled, pagers beeped, and cell phones were clipped to every belt? Back then, success was measured by how many laps you ran, not necessarily what place you finished. The fee-for-service model was the obvious course, and “quality” was more of a suggestion than a checkpoint.

To be fair, a few trail markers had been scattered along our path, helping us stumble toward a starting line we hadn’t realized existed. In the 1970s, federal legislation began setting up bright orange cones for managed care, prompting questions like, “Is that detour really necessary?” and “Do we actually need another aid station?” Then, in the 1980s, Medicare rolled out Diagnosis Related Groups (DRGs) that provided a fixed payment per hospital stay for a given diagnosis in a way that acted as a pacer for hospitals nudging them to start thinking about efficiency and resource use.

By the 1990s, these hints gained momentum. Commercial payers borrowed managed care concepts, and “paying for quality” rather than just volume slowly entered the rulebook. Protocols, clinical pathways, and best-practice guidelines started setting up random aid stations that may be well-marked or easily missed. The 90s handed out a lot of confusing course maps that nobody was quite sure how to follow. Quality departments started popping up for those with the resources to provide a race crew, but most consisted of a lone, brave runner navigating with a hand-drawn map and a compass (ever heard of the Barkley Marathon – look it up).

Meanwhile, the outside world cheered from the sidelines. The Joint Commission (then JCAHO) moved beyond compliance and clipboards, introducing the ORYX initiative in 1997 to require hospitals to collect and submit performance data. Suddenly, the race had official timekeepers. U.S. News & World Report launched the first mid-race public leaderboard whether the runners wanted the extra pressure or not. It’s just a friendly little competition right, even if no one agreed on where the finish line was and the runners had never signed up for the race. Suddenly, every step was timed and measured, but the route was still up for debate.

Of course there are steps forward in better healthcare during this error:

• Accountability: Early quality programs brought more transparency and focus on outcomes (at least for those who realized the race had started).

• Teamwork: Multidisciplinary teams and clinical pathways encouraged collaboration to break down silos (maybe even sharing snacks when the aid stations ran out or couldn’t be found).

• Focus: Utilization management and DRG payments made people think twice before sprinting down an unmarked trail just to ‘see the view’ (not always a wrong move, but not always reimbursable either).

If you have ever run a race, especially a trail, you know that no matter how well-prepared you are, a stumble or two is part of the journey:

• Data Overload: Every new checkpoint meant more paperwork, more reports, and sometimes losing track of the course entirely.

• Checklist Fatigue: Protocols could turn into box-ticking, risking the loss of personal touch in patient care in exchange for passing a compliance check (which meant foregoing your running style just to pass a competitor).

• Ranking Stress: Competition for top spots could make improvement feel like chasing a number rather than chasing better outcomes.

By the early 2000s, “quality” wasn’t just a buzzword, it had become a department, a strategy, and a moving target. Healthcare was adapting to the chaos of the unmarked course, keeping pace right behind the data, rankings, and the public scoreboard. The Value-Based Care race was underway, even if most runners were still trying to find the first aid station, figure out how many miles were ahead, or what the finish line look like, and that is assuming they even realized they were in the race at all.

But alas, that’s the beauty (and the humor) of healthcare transformation: an uncharted run on ever-changing terrain, hoping you have the right shoes and the stamina to keep going.

Part II will pick up the pace as the course adds new trail markers, timing chips, and a few more runners finally realizing they’re in the race.