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

Timing Chips, Scoreboards, and the Sprint Toward Value

Runners were placed at random spots along the course, and some were noticing their performance. The race in healthcare had intensified; following the runner ahead no longer guaranteed you were on the right path. Now, speed and strategy were essential.

Hospitals, once like relaxed weekend runners, suddenly faced public scoreboards and rankings from U.S. News & World Report. Reputation now depended on leaderboards that provided runner details, though few grasped what it truly meant to “win.” Rules changed constantly, often handed out mid-race. “Door-to-Doc in 5 minutes” programs looked good on paper but ignored the real obstacles like fallen trees and steep hills faced by those running the race. Protocols, however clever, were rarely followed because they felt disconnected from clinical reality.

Instead of supporting the runners, each new rule felt like another hurdle. The only way forward was to improvise, sharing tips at crowded aid stations and hoping the next switchback brought relief. In this unpredictable terrain, only those with endurance and resilience kept going.

The push for standardization promised better outcomes and lower costs but brought more oversight. The rules and the runners’ standings went public with the CMS Hospital Quality Initiative in 2003. Suddenly, patient satisfaction, readmission rates, infections, and more were tracked for all to see, but without context for what those numbers meant. As poor scores led to financial penalties, hospitals were forced to focus on looking good rather than removing real barriers to care. To avoid penalties, administrative resources and focus shifted away from bedside care, leaving clinical staff with fewer hands-on deck and more boxes to check. What used to be the occasional prep for The Joint Commission visit now became the new normal.

“What gets measured gets managed,” was set in stone. Healthcare was no longer judged by the care delivered, but by rankings on a mid-race leaderboard that implied how well they delivered care.

Now, a new formula appeared: in 2006, Porter & Teisberg published “Redefining Health Care” that encouraged chasing outcomes, not just activities. The new equation for value was becoming official. Improving quality gained acceptance, but nobody agreed on how to measure it. Suddenly, clinical teams faced ultramarathon demands with sprinter-level budgets, trying to keep pace with relentless expectations.

The Affordable Care Act in 2010 changed the course again. Penalties for missing checkpoints or those with lower-than-expected performances became common. “Shared savings” and “bundled payments” were the new mid-race awards, though few understood how to earn them. Hospitals needed PR teams and risk managers to keep up with the new rules and public eye. Comparing runners felt more important than supporting them.

By 2015, the “half marathon” was over, but the switchbacks kept coming. The Medicare Access and CHIP Reauthorization Act (MACRA) forced physicians from the sidelines and into the race, linking their pay to performance and cost. Now, everyone had a timing chip, but still few understood the map.

Healthcare split into two races: short sprints for fee-for-service cash just to keep the doors open and a grueling value-based ultramarathon full of penalties. Administration and clinical teams now had to take separate routes, planning to reunite later. The result: overwork, exhaustion, and unmarked trails. Clinical staff were burdened with growing documentation requirements and frustration, while personalized patient care secretly suffered.

Administration found it more difficult to keep up with how the clinical team was running, so they started developing their own scoreboards to track performance.

Just as teams adjusted to the relentless pace, COVID-19 reshaped the terrain yet again, demanding even greater resilience, innovation, and unity. Burnout skyrocketed as the race obstacles multiplied. The saga of electronic health records and its impact deserve its own series, but its influence on the race is undeniable.

Every change meant to guide the way instead crowded the course, leaving clinical healthcare workers fatigued, overwhelmed, and further from the finish line of patient-centered care.