How To Shift To Value-Based Care
For many organizations, the shift to value-based care will require extensive investments in technology and population health management resources. To offset these costs, many providers are considering collaborations with health plans to carry out these models. In fact, 64% of today’s value-based care models involve a health plan and provider collaboration.
These relationships can be mutually beneficial. Health plans can benefit from the providers’ deep understanding of patient-centered care and their roles as trusted clinical experts. Providers need to leverage the health plan’s experience in predicting and managing risk. Many payers also contribute advanced analytics, patient engagement tools and care management programs. These resources can dramatically offset the model’s start-up costs. At the same time, these relationships allow providers to take advantage of new avenues for reimbursement.
However, even with this combined expertise, there is still much work to be done. To create a sustainable model, providers and health plans must design and deploy an effective population health management program. This includes the identification of standards and risk categories of patient groups as well as development of agreed-upon quality measures and targets for improvement. Implementing a technology platform to share patient and population information between the payer, providers and clinical extenders will be a crucial early step.
However, simply connecting and integrating volumes of patient data will not allow for targeted, data-driven patient insight. Advanced analytics are required to pinpoint individuals who would benefit most from interventions. This patient insight can help organizations identify and manage risk, improve care and assess performance. Another key use for health information technology is to integrate the patient data into workflow tools that provide real-time decision-making support at the point of care. These solutions match targeted patient data against evidence-based clinical recommendations. This approach can reduce the amount of time providers spend reviewing volumes of patient data and clinical best practices. As a result, providers have additional inputs to inform their treatment decisions. This can free up time for patient care.
Traditionally, providers have been focused on caring for patients when they come for a checkup or sick visit. But this is changing. Supporting patients between these visits is crucial to helping individuals make lasting health improvements. Fortunately, many payers are experienced in using claims-based analytics to track patient adherence, then using care management programs and outreach to ensure their conditions are monitored and managed effectively to prevent complications.
Many payers have also harnessed the power of mobile applications and social media to reach out to their members. These resources can be deployed within a value-based care model to support patient engagement efforts and demands for more convenient access to health care.
Mobile applications can guide patients to providers within the network that are suited for the patients’ health needs, engage patients in programs to improve their health, and foster patient allegiance to a payer and provider by enabling access to personal health records, appointment setting and electronic visits.
It is evident that in this new era of value-based care, collaboration is key. Opportunities to improve quality can emerge from better patient/physician communication, improved coordination among providers and through these strategic relationships between payers and providers. New technology is also providing an essential foundation to support this collaboration by fostering better communication and knowledge sharing across the spectrum of care. Thanks to these information technology resources, payers and providers will not only be able to leverage their collective strengths—they can actually enhance them.
As a result, payer/provider relationships will truly offer “the best of both worlds” for organizations that want to lead the charge to value-based care.
Charles Kennedy, M.D., is the chief executive officer of Aetna Accountable Care Solutions.
