How to overcome it
Peter Bresler, practice leader, health system consulting, Willis Towers Watson, points out that health plans have somewhat opposite challenges than health systems when it comes to value-based care, particularly with respect to the employer segment.
For years, major national carriers have served as the administrative and network partner for employers’ self-funded plans. They typically have deep knowledge and extensive relationships with employer decision-makers, and have been the first to introduce value-based arrangements to employers. “However, value-based care requires intensive clinical collaboration and a patient-centered focus, and carriers have been challenged to effectively drive these changes at health systems within their networks,” he says. “While there have been some success stories in driving value by carriers, through their experience in fully insured markets as well as with specialized buy-up care management programs, their role as intermediaries limits their ability to drive the clinical and operational changes required at the health system level.”
To succeed in the value-based world, health plan leaders need to develop a frank, honest perspective on where they have a unique, sustainable advantage for both payers and providers in the value-based world, and build their services and solutions around their strengths, says Bresler. For example, in some markets carriers may have an extremely well-developed network of hospitals and providers that offer high-quality, low-cost care. Their network depth and breadth can be leveraged in developing value-based offerings.
Anand Shroff, founder and chief development officer, Health Fidelity, a comprehensive risk adjustment solutions firm, says networkwide organizational alignment is key to overcoming challenges and succeeding in value-based care for payers and providers. “Designing processes that get rid of redundancies can save costs for both parties,” he says. “Creating financial incentive structures that successfully align the interests of provider groups and health plans will inherently build momentum toward the same outcome. Setting up a technology infrastructure where data sharing becomes effortless will be critical to removing the impediments that currently exist for organizations shifting toward value-based care.”