Value-based payments, which reward doctors for treating the whole person instead of specific pains and aches, are critical for lowering health care costs, as you have editorialized (“A necessary prescription for MassHealth,’’ April 29). But such payments must reward doctors fairly. For instance, we can’t lump all diabetes patients together for purposes of paying doctors. A diabetes patient with heart disease is much riskier and requires more money to treat, especially given the likelihood he’ll go to the emergency room at some point. Throw in another condition, such as depression or knee problems, and you complicate the calculations even more. Already, research has shown that facilities in neighborhoods with poorer patients get under-reimbursed for handling their needs. We do not have the fine-grained insights yet to anticipate what comprehensive treatment for each patient will cost. The solution may have to wait several years until the federal Precision Medicine Initiative builds up enough big data to better match the real costs of treatment.

Andrew Oram

Arlington