Paul Levy, the former president and CEO of Boston’s Beth Israel Deaconess Medical Center, argues the move towards value-based care is “likely to be an energy-sapping distraction” based on false assumptions about providers' behavior.

Writing for Athena Insight, Levy compared the system to a Harvard Business School game called “Win as Much as You Can,” designed to show “how difficult it is to achieve sustainable cooperation within a structure that pushes people to behave selfishly.” To him, this summarizes the problems with value-based payment, particularly global payments like what an accountable care organization receives, with physicians being dissatisfied with the bonuses for working within the new system and falling back to their old methods.

“At the end of year one, the time you have spent seeing patients has increased because of the new care management protocols adopted by your health system,” Levy wrote. “You've received no extra payment for that time spent, and you discover that your share of the surplus is tiny relative to your previous income, while your quality of life has declined because you're spending more time in the clinic.”

The real place to find value, Levy argued, is to focus on disintermediation.

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