Best Practices in Value-Based Care

October 26, 2019

As payers work toward successful value-based care arrangements, there are several best practices to keep in mind.

As payers work toward successful value-based care arrangements, there are several best practices to keep in mind, according to Angie Meoli, senior vice president of network strategy and provider experience, at Aetna.

At the 2019 Value-Based Innovation Summit hosted by the Cleveland Clinic, Meoli co-presented “Best Practices in Value-Based Innovations,” with Winjie Tang Miao, senior executive vice president and chief experience officer at Texas Health Resources, a northern Texas faith-based, nonprofit health care delivery system.

Managed Healthcare Executive (MHE) asked Meoli about what value-based care means, changes on the horizon, and her best advice when it comes to value-based care arrangements.

MHE: Please explain what value-based care means in a payer’s world?

Meoli: It’s essential that payers focus on the health needs of the consumer. Value-based care arrangements align provider payment structures with achieving healthcare outcomes rather than the volume of services they perform. By working with providers through value-based arrangements, payers can help improve health outcomes and affordability for consumers.

MHE: Why is this being addressed?

Meoli: The average American family is spending significantly more for healthcare than they did 10 years ago but is not realizing full value for the added cost. Among high-income countries, the U.S. ranks last in healthcare system performance in many areas, despite spending the most. That disparity between outcomes and cost to families has been driving the industry away from fee-for-service to value-based care arrangements, changing the way healthcare is paid for, coordinated, and evaluated.

MHE: What changes are on the horizon?

Meoli: The influence of factors such as individual behaviors, genetics, as well as our social and environmental circumstances and other social determinants of health, are getting more attention. Payers should change how they define provider networks by including services that address the health of the whole person, such as their physical, mental, and social needs. For example, services like behavioral health and those that address social determinants of health can help achieve better health outcomes, which closely aligns with the objectives of value-based care.

MHE: What are a few pieces of advice for payers when it comes to value-based care?

Meoli: There are several things payers can keep in mind as they work to make themselves and their providers successful in value-based care arrangements.

  • Each provider is unique related to their infrastructure, technology capabilities, and other factors that impact their ability to take on risk. Payers should offer value-based arrangements that support providers where they are in the value-based care continuum and enable them to progress toward higher risk arrangements over time.
     

  • Payers should provide technology-driven tools so provider relationships can more easily succeed in value-based care arrangements. For example, providing population health and point-of-care platforms can help providers manage outcomes through performance and quality analytics.
     

  • Payers should innovate to deliver new solutions and models of care that enable risk-sharing. For example, Aetna’s value-based care models include five joint ventures that build upon foundational value-based care models and support risk sharing so the interests of providers, Aetna and consumers are fully aligned.

Briana Contreras is associate editor for Managed Healthcare Executive.