Implementing value-based care
Only 40% of respondents to our survey have started initiatives toward value-based care. Furthermore, only 30% said their compensation is value driven.
“Most payers and providers have been operating under a fee-for-service model, so changing to value-based care can be intimidating, complicated, and expensive,” says Jay LaBine, MD, chief medical officer, naviHealth, a post-acute care management company that manages risk.
While health plans aim to create value and provide better member experiences through improvements in the quality of care and reduced costs, providers have their own ideas and priorities for how to create value. “This is particularly evident as consolidation activity for healthcare providers has escalated over the last 10 years,” LaBine says. “Hospital consolidation has created more buying power on the provider side, therefore putting more strain on payers to implement their own member-focused programs to drive value.”
Related article: Value-Based Care: Gaining Ground or Losing Steam?
Kate Grohall, product executive for value-based care at SKYGEN USA, which offers technology solutions for payers and providers, says now that payers are accepting more risk for outcomes under value-based care, they need to build programs and infrastructure that support a more concierge type relationship with members, enabling member engagement and improved healthcare choices. “In other words, they need to go from being the bank when it’s time to pay for care to being a trusted resource and advocate of member savings, quality outcomes, and overall care experience,” she says. “This isn’t an easy transition.”
Meanwhile, providers have huge concerns about how they will transition their business models away from being primarily fee-for-service. “They will have to redesign work flows and create new clinical pathway management strategies with their frontline clinical staff to become successful at managing an entire episode of care,” Grohall says. “Hospitals must also completely revamp their provider contracting strategies and compensation models to align with value-based care delivery and payment models.”
How to deal
To overcome challenges associated with creating a value-based environment, health plan executives should collaborate with large health systems to foster greater change within the care continuum. LaBine says this can be accomplished through value-based contracts focused on improving patient experience, patient quality of care, and reducing costs. Health plan executives can overcome challenges by communicating their goals for improved value for their members to patients and providers.
Health plan executives should also consider communicating price transparency directly to their members, LaBine continues. By going straight to healthcare consumers, health plans can encourage members to elect less expensive procedures or services that still achieve the same outcome. “Health plans need to engage with and educate their members, and providers will follow suit,” he says.